Biomedical subjects

B Stegenga

Publications and source records attributed to B Stegenga.

At least 55 records · Page 3Linked to original sources

PubMed1999

The smallest detectable difference of mandibular function impairment in patients with a painfully restricted temporomandibular joint.

Mandibular functions such as speech, laughing, yawning, mastication, and taking a large bite may be impaired if temporomandibular disorders exist. The Mandibular Function Impairement Questionnaire is a validated instrument that scores perceived difficulty of representative mandibular functions in relation to jaw complaints. However, the reliability of the Mandibular Function Impairment Questionnaire has never been adequately tested. Generalizability and decision studies are currently proposed to assess the reliability of a measurement device. The smallest detectable difference is the smallest statistically significant amount of change to be detected with a measurement device. The purpose of this study was to assess the reliability of the Mandibular Function Impairement Questionnaire in terms of the smallest detectable difference. Twenty-five consecutive patients with painfully restricted temporomandibular joints completed the Mandibular Function Impairement Questionnaire on two separate measurement days, one week apart, using two consecutive sessions per day. Spearman's r was calculated for test-retest reliability. Variance components such as patients, measurement days, repetitions, and all their interactions were analyzed in the generalizability study. In the decision study, the smallest detectable difference was calculated for different days and repetitions. Spearman's r varied from 0.69 to 0.96. The between-patient variance and the error variance contributed 81% and 19% to total variance, respectively. The Mandibular Function Impairment Questionnaire is a reliable instrument for the assessment of mandibular function impairment. The minimal amount of change to be detected is 14 units on a scale of 0 to 68. Reliability in terms of the smallest detectable difference increases if the measurement is repeated twice on two separate days: The smallest detectable difference improves to 10 units.

Adult↗

PubMed1999

Long-term results of nonsurgical management of condylar fractures in children.

Twenty-five patients with 28 condylar or subcondylar fractures, sustained during their growth period and treated nonsurgically, have been followed for an average period of 15 years. The fractures were classified as intracapsular, high condylar neck and low condylar neck fractures. In 5 patients, two weeks of intermaxillary fixation, followed by elastic traction in order to achieve a proper occlusion, was applied. All the other patients were treated by instruction, exercises and observation. In 4 patients, subsequent orthodontic treatment was provided. It is not advocated to perform orthodontic aftercare as a routine action in all patients. Satisfaction with the treatment results, as measured on a visual analogue scale (VAS), was very high. The masticatory function of all patients at last follow-up was good to excellent. From this study, it appears that especially the commonly occurring high condylar fractures (64%) show good regeneration tendency as observed on radiographs. Low condylar and intracapsular fractures may give rise to some asymmetry. In 4 cases this asymmetry was clearly visible to the experienced observer, but did not concern the patient. One patient (low condylar neck fracture) showed obvious malocclusion and facial asymmetry, which needed to be corrected by orthognathic surgery. Unfortunately, it is impossible to predict which type of fracture is at risk of facial asymmetry. It is concluded that nonsurgical management of condylar fractures of the mandible in children is still the method of choice.

Adolescent↗

PubMed1998

Ratio between vertical and horizontal mandibular range of motion.

Mandibular range of motion (ROM), vertical and horizontal, is often measured as a part of a diagnostic assessment of temporomandibular joint disorders. In the literature, a fixed ratio between the vertical and the horizontal ROM has been suggested, i.e. 4:1. The ratio is frequently used to predict the vertical ROM on the basis of the horizontal ROM and vice versa. However, no scientific data are available to substantiate the ratio suggested. The aim of this study was to determine whether the fixed ratio of 4:1 exists and, if so, whether this ratio has a predictive value. Vertical and horizontal mandibular ROM was measured in 91 healthy subjects, 59 women, and 32 men (mean age 27.2 years, s.d. 7.4 years) using vernier callipers. We found a mean ratio between vertical and horizontal ROM ranging from 6.0:1-6.6:1. On an individual basis the ratio ranged from 3.6-15.5. Correlations between vertical and horizontal ROM were weak. On the basis of the results on this study it is concluded that the ratio between vertical and horizontal ROM is approximately 6:1 rather than 4:1, and that the ratio has poor predictive value.

Adolescent↗

PubMed1998

[Complaints and complications associated with removal of the mandibular third molar. A prospective clinical study].

OBJECTIVE: To study the incidence of complaints and complications after removal of the mandibular third molar and to evaluate the influence of this procedure on functioning of the patient during the first post-surgical week. DESIGN: Prospective, clinical. SETTING: Department of Oral and Maxillofacial Surgery, University Hospital Groningen. METHODS: Patients referred for removal of a mandibular third molar were asked to return one week after the procedure and to keep a daily record of the use of pain medication, duration of the pain and intensity of the pain. RESULTS: Removal of mandibular third molars resulted in an overall complication rate of 12%. Pain medication was used more frequently and for a longer period by patients with post-surgical complications. Due to complaints following the removal of the mandibular third molar, the mean absence from work was one and a half day. Work was generally resumed with decreased perceived efficiency. CONCLUSION: After this commonly performed procedure in dento-alveolar surgery most of the patients were hampered as a result of pain during the first four post-surgical days. Over 10% of the patients developed complications leading to more frequently and prolonged use of pain medication. Removal of the mandibular third molar gave rise to complaints which influenced the patients relatively strong in their daily functioning.

Absenteeism↗

PubMed1998

Overdentures stabilised by two IMZ implants in the lower jaw--a 5-8 year retrospective study.

Clinical and radiographical parameters were assessed in forty patients with overdentures stabilised by two IMZ implants connected by a bar in the lower jaw in a 5-8 years retrospective study. Results indicated that most patients had healthy peri-implant tissues, the mean pocket probing depth was 3.1 mm and the median periotest value was -4. Three implants were removed after the healing period and replaced by three new implants. One implant was lost after six years. One implant was mobile on palpation. None of the patients showed objective signs of dysaesthesia in the lower lip or chin. The peri-implant bone level of most implants had remained stable after one year of service. The overall success rate was 94% (Albrektsson et al.) and it is therefore concluded that two IMZ implants, connected with a bar in the lower jaw, provide a stable base for long-term support of a mandibular overdenture.

Adult↗

PubMed1997

Epidemiology and natural progression of articular temporomandibular disorders.

The reported prevalence of temporomandibular disorders (TMDs) differs from study to study, probably because of methodologic errors and lack of standardized definitions of TMDs and their characteristics. Classification of TMDs should be in accordance with classification of synovial joint disorders as generally used by rheumatologists and orthopedic surgeons, in which articular disorders are distinguished from nonarticular disorders. Articular temporomandibular disorders appear to be self-limiting in a very high percentage of cases. Because of this nonprogressive nature, the outcome of nonsurgical management will be highly successful.

Bursitis↗

PubMed1997

A controlled clinical trial of implant-retained mandibular overdentures: clinical aspects.

In a controlled clinical trial, treatment effects of mandibular overdentures on two different implant-systems in edentulous patients were compared one year after insertion of the new dentures. The implant-systems used were the Brånemark system (Brå) and the IMZ-system. Treatment was randomly assigned to 60 patients according to a balanced allocation method. Evaluation included peri-implant and radiographical parameters. According to the Delphi method a clinical implant performance scale (CIP) was constructed based on all conceivable complications of the different implant systems. During the osseointegration period, five Brå- and one IMZ-implants were lost. The results of one of the peri-implant parameters and the radiographical score showed significant differences considering the (pseudo) pocket probing depth (Brå better than IMZ, P < 0.001) and the radiographic-score (IMZ better than Brå, P < 0.003). The results for the CIP-scale were less favourable for the Brå-group than for the IMZ-group; however, these differences were not significant.

Adult↗

PubMed1996

Hard and soft tissue imaging of the temporomandibular joint 30 years after diagnosis of osteoarthrosis and internal derangement.

PURPOSE: This article describes the clinical and imaging findings in the temporomandibular joints (TMJs) of patients 30 years after the initial diagnosis of osteoarthrosis and internal derangement. PATIENTS AND METHODS: Fifty-five TMJs with a history of osteoarthrosis and internal derangement and 37 contralateral TMJs that were asymptomatic 30 years ago were examined in 46 former patients. To visualize degenerative changes of the bony parts of the TMJ, transpharyngeal and transcranial radiographs were made; to visualize disc position, sagittal T1-weighted magnetic resonance (MR) images were made. For comparison, 22 TMJs of an age-matched control group without complaints related to the masticatory system were similarly examined. RESULTS: Thirty years after the initial diagnosis of osteoarthrosis and internal derangement, clinical signs in former patients hardly differed from those of control subjects. radiographic signs were significantly more common and more severe in former patients. A high percentage of osteoarthrosis and internal derangement was seen on MRI in both TMJs with a history of osteoarthrosis and internal derangement and in the contralateral TMJs. It appeared that osteoarthrosis and internal derangement in the contralateral TMJs had developed asymptomatically in most cases. None of the patients had required treatment for the contralateral TMJ; only one fourth of the patients had noticed symptoms. In the control subjects, osteoarthrosis and internal derangement were infrequently seen. A significant correlation was found between disc position and the severity of radiographically detectable degenerative changes of the TMJ. CONCLUSIONS: It was concluded that 30 years after initial diagnosis there were few clinical signs of osteoarthrosis and internal derangement, although radiographic signs were extensive. Bilateral osteoarthrosis and internal derangement, with one symptomatic and one asymptomatic TMJ, is a common phenomenon. Moderate to severe radiographically detectable degenerative changes may be the only sign of an underlying internal derangement.

Adaptation, Physiological↗

PubMed1995

TMJ articular disc position and configuration 30 years after initial diagnosis of internal derangement.

PURPOSE: This study evaluates disc position and configuration on magnetic resonance imaging (MRI) in temporomandibular joints (TMJs) with a long history of internal derangement. PATIENTS AND METHODS: Sagittal T1-weighted MRIs of 55 TMJs that were diagnosed with internal derangement approximately 30 years ago were made with the mouth closed and open, and the position and configuration of the articular disc were determined. For comparison, a control group consisting of 15 asymptomatic TMJs without clinical signs of internal derangement or of other TMJ disorders were studied in the same way. RESULTS: Anterior disc position was found in 90% of the TMJs with a history of internal derangement. Reducing disc displacement was found in one third of these TMJs, whereas permanent displacement was found in two thirds. In four joints, no disc was discernible. In one of the joints of the control group, a permanent disc displacement was found; normal disc position was found in all other joints of the control group. A biconcave disc configuration, which was considered normal, was found only in TMJs with normal disc position or with reducing discs. CONCLUSION: It was concluded that, after 30 years of displacement, the TMJ disc can be clearly identified on MRI in most cases. If the disc becomes permanently displaced, its configuration deviates from the normal biconcave configuration, and its anteroposterior length decreases. Convex and folded appearances of the disc are common in this situation. However, the disc usually maintains its biconcave configuration as long as it resumes its position on top of the condyle during mouth opening, even if this condition lasts for several decades.

Aged↗

PubMed1995

Patient satisfaction and chewing ability with implant-retained mandibular overdentures: a comparison with new complete dentures with or without preprosthetic surgery.

PURPOSE: The objective of this study was to compare denture satisfaction and chewing ability of edentulous patients treated with dental implant-retained overdentures or with full dentures with or without previous preprosthetic surgery. PATIENTS AND METHODS: This study was a controlled clinical trial. Thirty-eight men and 52 women participated in the study. The mean height of the anterior mandible was 21 mm (range, 16 to 25 mm), measured on a lateral cephalometric radiograph. The subjects were randomly assigned to the three treatment modalities. The main outcome measures were denture satisfaction and chewing ability, which were assessed using questionnaires focusing on denture-related complaints and the ability to chew different types of food, and an overall denture satisfaction score. RESULTS: Based on the baseline data from the "denture complaints" and "chewing ability" questionnaires, nine interpretable factors could be extracted. Two factors did not vary following treatment and were excluded from the outcome analysis. At the 1-year evaluation five of seven factors showed significantly better scores for the two surgical groups than for the control group. The same was found for the overall denture satisfaction rate. CONCLUSION: Overdentures retained by dental implants or complete dentures made after a vestibuloplasty and deepening of the floor of the mouth provide a more satisfactory solution for denture-related problems than complete dentures alone. For the scale "functional complaints lower denture," the overdenture group showed even a significantly better score than the preprosthetic surgery group.

Cephalometry↗

PubMed1995

Radiographic signs of temporomandibular joint osteoarthrosis and internal derangement 30 years after nonsurgical treatment.

The aim of this study was to evaluate with radiographs the long-term status of temporomandibular joints that were treated nonsurgically for reducing disk displacement (group 1) or permanent disk displacement (group 2) 30 years ago. Transcranial and transpharyngeal radiographs were made before (T1), 2 to 4 years after (T2), and 30 years after (T3) nonsurgical treatment in 65 former patients with temporomandibular joint osteoarthrosis. To control the results for aging 35 matched subjects (group 3) underwent the same radiographic examination. The number and severity of radiographically visible degenerative changes increased significantly from T1 through T2 to T3 in group 1 and in group 2. The increase in these changes was not simply caused by aging, because in approximately three quarters of the temporomandibular joints in group 3, no radiographically visible degenerative changes were found. At all occasions group 2 showed significantly more severe changes than group 1. At T3 in 64% of the temporomandibular joints in group 1, no or only slight radiographically visible degenerative changes were observed, whereas in 86% of the temporomandibular joints in group 2, moderate to severe changes were observed. A persisting reducing disk displacement in part of the temporomandibular joints in group 1 might explain this significant difference. In 79% of the temporomandibular joints with moderate to severe radiographically visible degenerative changes at T1, no or only slight progression in the extent of these changes was seen between T2 and T3. Apparently a radiographically stable end stage may be reached within a few years after permanent displacement in most cases. It was concluded that in temporomandibular joints with reducing disk displacement, no or only slight radiographically visible degenerative changes develop, even if this condition persists for several decades. On the other hand, in temporomandibular joints with permanent disk displacement, radiographically visible degenerative changes are extensive in the vast majority of cases.

Case-Control Studies↗

PubMed1995

Symptoms of temporomandibular joint osteoarthrosis and internal derangement 30 years after non-surgical treatment.

To evaluate the long-term condition of temporomandibular joints (TMJs) affected by osteoarthrosis and internal derangement, 99 patients treated non-surgically between 1958 and 1962 were recalled for follow-up. The patients, 16 men and 83 women (mean age 58.2 years) with either reducing or permanent disk displacement, were submitted to a structured interview concerning previous treatment, masticatory function, and the presence of symptoms of osteoarthrosis and internal derangement of the masticatory system, and of complaints of the musculoskeletal system in general. A control group, consisting of eight men and 27 women (mean age 58.9 years) without complaints of the masticatory system, matching the patient group for sex, age and state of dentition, was included in the study to avoid simply documenting age-related joint conditions. Satisfaction with the treatment outcome was high. Chewing ability of the the patients did not differ from that of the controls, although patients more often expected pain and difficulty with opening the mouth wide. The main TMJ symptoms of the patients had decreased significantly; patients reported joint noises more often than controls. It is concluded that, despite some persisting symptoms, the non-surgical treatment approach of TMJ osteoarthrosis and internal derangement provides long-lasting satisfactory subjective results and is well-accepted by the patients.

Cartilage, Articular↗

PubMed1995

Angle of mouth opening measurement: reliability of a technique for temporomandibular joint mobility assessment.

The maximal interincisal distance added to the vertical overlap is generally used as a measure for temporomandibular joint mobility. However, the length of the mandible also has an influence on this measure. The angle of mouth opening as a measure of temporomandibular joint mobility is independent of the length of the mandible. The aim of the study was to develop a mandibular goniometer to measure the angle of mouth opening and to test its reliability. Ten subjects, two males and eight females (mean age 28.1 years) participated in the study. The measurements were performed during four independent sessions of three measurements each. The results were analysed with ANOVA. Intra-observer variability was found to be 2.0 degrees when the result of all the measurements were analysed, and were found to be 1.2 degrees when the mean value of the sessions were used for analysis. Based on the results of this study it can be concluded that the angle of mouth opening can be measured reliably.

Adult↗

PubMed1995

Temporomandibular joint mobility assessment: a comparison between four methods.

Temporomandibular joint (TMJ) mobility is assessed in different ways. Measurement of the interincisal distance in maximal mouth opening added to the vertical overlap of the dentition, i.e. linear mouth opening (LMO); measurement of angular displacement of the mandible relative to the cranium at maximal mouth opening, i.e. angle of mouth opening (AMO); assessment of the condylar position relative to the articular eminence performed on transpharyngeal radiographs in maximal mouth opening, i.e. condylar mobility (CM); measurement of angular displacement of the mandible at maximal mouth opening relative to the closed mouth position of the mandible, assessed on transpharyngeal radiographs in maximally opened and in closed mouth position, i.e., radiographic angle of mouth opening (RAMO). To compare these TMJ mobility assessment methods and to analyse the relationship between LMO, AMO and mandibular length (ML), 28 healthy volunteers (13 females, 15 males), mean age 29-6 years (range 21-41) with a symmetrical mouth opening pattern were assessed. LMO, AMO, ML, and RAMO were measured and CM was assessed on transpharyngeal radiographs. LMO and AMO were strongly and significantly related (r = 0.71). LMO was significantly influenced by AMO and ML. No significant differences between AMO and RAMO were found. CM was strongly and significantly related to AMO (r = 0.72) and weakly but significantly related to LMO (r = 0.42). Based on the results of this study recommendations are made regarding the appropriate application of TMJ mobility assessment methods.

Adult↗

PubMed1995

Complications after mandibular third molar extraction.

The records of 1,797 patients were retrospectively examined to analyze the possible relationships between postoperative complications following mandibular third molar extraction and parameters such as age, sex, indication for surgery, position of the molar, surgical experience, surgical technique, and postoperative care. Older patients tended to suffer more often from complications. Surgery performed while there were signs of pericoronal inflammation also resulted in more complications. There was no statistically significant difference in the mean complication rate arising from surgery performed by staff members and the rate when surgery was performed by residents. There seems to be no reason for patients to return routinely for removal of resorbable sutures or other postoperative care because this practice does not result in a decrease in postoperative symptoms.

Adolescent↗

PubMed1994

Histologic evaluation of computed tomographic TMJ articular disk visualization.

The reliability of computed tomography (CT) for visualization of the temporomandibular joint (TMJ) articular disk has often been the subject of discussion. The success or failure of CT may be determined by different factors. This study was designed to evaluate the effect of these factors, such as type of equipment used, patient motion and artifacts on articular disk visualization, and also to assess the validity of the articular disk image in comparison with histological pictures. Ten TMJ autopsy specimens were collected after the teeth were placed in intercuspal position. The TMJ was deep frozen, dissected and kept frozen during subsequent CT scanning and histological processing. To study the influence of the specifications of the CT equipment on the visualization of the TMJ articular disk, two different CT units were used. The CT images were evaluated for interpretability and interpretation of articular disk position. The validity of the CT appearance of articular disk position and form was assessed by superposition of CT and histological pictures. The interpretability of the articular disk visualization in the CT images was very low. However, for CT images judged to be interpretable, there was a good degree of matching between the diagnosed articular disk position and form and the findings in the corresponding histological pictures. No significant differences between the two different CT units were noted. It is concluded that CT is inappropriate for TMJ articular disk visualization. Nevertheless, if the disk is visible on the CT image, its appearance represents the true position and form within the joint.

Adult↗

PubMed1994

[Treatment with soft laser. The effect on complaints after the removal of wisdom teeth in the mandible].

In a placebo controlled double-blind randomized study the effect of low level laser therapy on postoperative complaints after removal of lower third molars was examined. Several parameters were investigated in two groups of patients; in one group low level laser was applied during and following third molar removal, in the other no active additional laser treatment was given. The results of this study show that therapeutic low level laser treatment could not statistically reduce the postoperative pain, swelling, trismus and function impairment after extraction of lower third molars.

Adolescent↗

PubMed1994

Clinical signs of TMJ osteoarthrosis and internal derangement 30 years after nonsurgical treatment.

To evaluate the clinical course of temporomandibular joint osteoarthrosis and internal derangement, 99 patients who had received nonsurgical treatment for temporomandibular problems were reexamined 30 years after the original treatment. Results were compared with information obtained from patients' clinical examinations before and a few years after the original treatment as well as information from the clinical examination of 35 control subjects. During the first years after treatment, the main signs of temporomandibular joint osteoarthrosis and internal derangement decreased significantly. In the next three decades, very few changes were noticed. Clicking and crepitus were the most common remaining signs. These signs, however, did not appear to be bothersome to the patients. It was concluded that the disorders in question eventually reach a state of quiescence.

Adaptation, Physiological↗