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Michelotti A. An interview with Ambrosina Michelotti. Dental Press J Orthod 2018; 23:22-29. [PMID: 29898154 PMCID: PMC6018446 DOI: 10.1590/2177-6709.23.2.022-029.int] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/15/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ambrosina Michelotti
- » Graduated in Dentistry (DDS) in 1984. » Specialist in Orthodontics (1991). » Professor in pregraduate and postgraduate courses in Orthodontics and TMD at the University of Naples Federico II. » Associate professor in Clinical Gnathology. » Responsible of the Master course on "Orofacial Pain and Temporomandibular Disorders" at the University of Naples Federico II. » Published more than 100 papers in Italian and international journals, and has lectured extensively around the world. » President of the European Academy of Craniomandibular Disorders (2010). » President of the Neuroscience group of IADR (International Association for Dental Research) (2011). » President of SIDA (Società Italiana Disfunzioni ed Algie Temporomandibolari; 2012-2013). » President of the RDC/TMD Consortium at the IADR (2013-2014). » Associate Editor of the European Journal of Oral Science. » Associate Editor of the Journal of Oral Rehabilitation. » Member of the editorial board of the European Journal of Orthodontics. »Referee of several national and international journals
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Klenke D, Quast A, Prelog M, Holl-Wieden A, Riekert M, Stellzig-Eisenhauer A, Meyer-Marcotty P. TMJ pathomorphology in patients with JIA-radiographic parameters for early diagnosis. Head Face Med 2018; 14:15. [PMID: 30223858 PMCID: PMC6142390 DOI: 10.1186/s13005-018-0173-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is often accompanied by pathomorphological changes to the temporomandibular joint (TMJ). By analyzing orthodontical orthopantomograms of JIA patients the aims of the study were a) classification of condyle changes, b) quantification of bony asymmetries of condylar destruction and c) detection of relationships between disease duration and TMJ-involvement. PATIENTS/METHODS 46 caucasian JIA-patients (28 female; 18 male; < 16.0 years) were enrolled, each joint (n = 92) was morphologically assessed by means of orthopantomogram, quantitatively analysed and compared with duration of general disease. Condyle morphology was assessed using the Billiau scale for severity of destruction [1]. The quantitative analysis was based on ratios of condyle, ramus and mandible height. RESULTS Patients were divided into groups (Group I - slightly affected, n = 36; Billiau severity 0-2; condyle findings: X-ray normal, condyle erosions, condylar flattening; Group II - severely affected, N = 10; Billiau severity 3-4; condyle findings: condylar flattenings and erosions, unilateral/bilateral complete loss of condyles), based on morphological analysis of condylar destruction. Duration of disease was significantly longer in Group II (8.9 ± 5.2 years) than in Group I (4.6 ± 4.7 years). Asymmetries of condyle, ramus and mandible height, quantitatively analysed by contralateral comparison, were significantly more marked in patients of Group II than of Group I. CONCLUSIONS Orthopantomogram imaging can be used in orthodontics clinical routine to detect TMJ-pathologies and is an important reference for monitoring progression of JIA. Classification into severe and slightly affected TMJ is possible by analysis of condylar pathomorphology. An association between degree of destruction, extent of lower jaw asymmetry and disease duration is suggested by the results.
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Affiliation(s)
- Daniela Klenke
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany.
| | - Anja Quast
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany
| | - Martina Prelog
- Paediatric Department, Paediatric Rheumatology, Würzburg University Hospital, Würzburg, Germany
| | - Annette Holl-Wieden
- Paediatric Department, Paediatric Rheumatology, Würzburg University Hospital, Würzburg, Germany
| | - Maximilian Riekert
- Department of Orthodontics, Würzburg University Hospital, Würzburg, Germany
| | | | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany
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Resnick CM, Vakilian PM, Breen M, Zurakowski D, Caruso P, Henderson L, Nigrovic PA, Kaban LB, Peacock ZS. Quantifying Temporomandibular Joint Synovitis in Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2017; 68:1795-1802. [PMID: 27110936 PMCID: PMC5573997 DOI: 10.1002/acr.22911] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/02/2016] [Accepted: 04/05/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joints (TMJs) and is often undetected by history, examination, and plain imaging. Qualitative assessment of gadolinium-enhanced magnetic resonance images (MRIs) is currently the standard for diagnosis of TMJ synovitis associated with JIA. The purpose of this study is to apply a quantitative analysis of synovial enhancement to MRIs of patients with and without JIA to establish a disease threshold and sensitivity and specificity for the technique. METHODS This is a retrospective case-control study of children (age ≤16 years) who had MRIs with gadolinium including the TMJs. Subjects were divided into a JIA group and a control group. From a coronal T1-weighted image, a ratio (enhancement ratio [ER]) of the average pixel intensity within three 0.2-mm2 regions of interest (ROIs) in the TMJ synovium to that of a 50-mm2 ROI of the longus capitis muscle was calculated. Receiver operating characteristic curves were used to determine the sensitivity and specificity. The inter- and intraexaminer reliability was evaluated with Bland-Altman plots and 2-way mixed, absolute agreement intraclass correlation coefficients. RESULTS There were 187 and 142 TMJs included in the JIA and control groups, respectively. An ER threshold of 1.55 had a sensitivity and specificity for detecting synovitis of 91% and 96%, respectively. The inter- and intraexaminer reliability was excellent. CONCLUSION Calculating a ratio of pixel intensity between the TMJ synovium and the longus capitis muscle is a reliable way to quantify synovial enhancement. An ER of 1.55 differentiates normal TMJs from those affected by inflammatory arthritis.
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Affiliation(s)
- Cory M Resnick
- Boston Children's Hospital and Harvard School of Dental Medicine, Boston, Massachusetts
| | | | - Micheál Breen
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul Caruso
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lauren Henderson
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter A Nigrovic
- Harvard Medical School, Boston Children's Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Leonard B Kaban
- Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, Massachusetts
| | - Zachary S Peacock
- Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, Massachusetts
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Macedo de Menezes L, Deon Rizzatto SM, Martinelli Santayana de Lima E, Baccarin Matje PR, Picarelli MM. Juvenile idiopatic arthritis in orthodontics: Case report with a 6-year follow-up. Am J Orthod Dentofacial Orthop 2017; 151:384-396. [DOI: 10.1016/j.ajodo.2015.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/15/2022]
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Ok SM, Jeong SH, Ahn YW, Kim YI. Effect of stabilization splint therapy on glenoid fossa remodeling in temporomandibular joint osteoarthritis. J Prosthodont Res 2016; 60:301-307. [DOI: 10.1016/j.jpor.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
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Contemporary management of TMJ involvement in JIA patients and its orofacial consequences. EPMA J 2016; 7:12. [PMID: 27257443 PMCID: PMC4890481 DOI: 10.1186/s13167-016-0061-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/13/2016] [Indexed: 12/24/2022]
Abstract
Juvenile idiopathic arthritis is the most common chronic rheumatic condition during childhood. Temporomandibular joint arthritis is frequently asymptomatic. When it takes place during childhood, it may affect condylar growth; therefore, these children are at risk of unfavorable long-term outcomes from the associated joint damage. The etiology is not completely understood, but it is considered as multifactorial with both genetic and environmental factors involved. The standardized examination and imaging protocols serve important purpose to diagnose temporomandibular joint (TMJ) arthritis not only to establish an early interventional strategy but also to assess craniofacial growth and the progression of signs and symptoms in those patients. Although the treatment of juvenile idiopathic arthritis (JIA) has changed dramatically over the last decades due to new therapeutic options, TMJ arthritis still can develop during the course of the disease. In clinical experience, TMJs appear to respond less well to the standard of care used to treat other joints. More individualized approach to the patient’s treatment serves as the main goal of personalized medicine. It could be achieved by adopting new methods of medical imaging such as conebeam computer tomography as well as developing reliable biomarkers which may assist with predicting disease type, course, or severity and predicting response to medication. This article provides an overview of current information on orofacial complications in JIA and its management. Based on information provided in this review, more precise diagnosis, proper tools for recognizing people at risk, and more efficient treatment approaches could be implemented. This may lead to more personalized treatment management strategies of TMJ complications of JIA patients.
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Quantifying Synovial Enhancement of the Pediatric Temporomandibular Joint. J Oral Maxillofac Surg 2016; 74:1937-45. [PMID: 27067062 DOI: 10.1016/j.joms.2016.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The purposes of this study were to assess a novel method for quantifying temporomandibular joint (TMJ) synovial enhancement on gadolinium-enhanced magnetic resonance imaging (MRI) and to establish normative values to allow early detection of synovitis. MATERIALS AND METHODS This is a retrospective cohort study of pediatric patients (aged 0 to 16 years) without jaw pathology who underwent MRI scans with contrast that included the TMJs. From a coronal T1-weighted image, the signal intensity within the superior and inferior joint spaces was divided by the signal intensity of the longus capitis muscle to establish a ratio by age. Intrarater reliability and inter-rater reliability were assessed. A mixed-model regression analysis was used to determine the 95% specificity threshold for normal ratios. RESULTS Temporal and optic nerve MRI scans of 158 patients were included. Normative synovial enhancement ratios (95% specificity) thresholds were established: 1.52, 1.68, and 1.55 for superior joint space, inferior joint space, and average of both joint spaces, respectively. Intrarater and inter-rater agreement was excellent. CONCLUSIONS A ratio of signal intensity of the TMJ synovium to the longus capitis is a reliable method to quantify enhancement controlling for time after contrast infusion and may be useful for diagnosis of TMJ synovitis.
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El Assar de la Fuente S, Angenete O, Jellestad S, Tzaribachev N, Koos B, Rosendahl K. Juvenile idiopathic arthritis and the temporomandibular joint: A comprehensive review. J Craniomaxillofac Surg 2016; 44:597-607. [PMID: 26924432 DOI: 10.1016/j.jcms.2016.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/12/2015] [Accepted: 01/26/2016] [Indexed: 11/29/2022] Open
Abstract
Juvenile idiopathic arthritis is the most common inflammatory rheumatic disease of childhood and represents a series of chronic inflammatory arthritides of unknown cause. Involvement of the temporomandibular joint has been reported in up to 87% of children with juvenile idiopathic arthritis when based on magnetic tomography imaging; it can be asymptomatic and may lead to severe long term complications. In this review a summary of the contemporary literature of imaging of the temporomandibular joint in children with juvenile idiopathic arthritis will be provided, including ultrasound which is a valuable method for guided joint injections, but does not necessarily allow detection of acute inflammation, cone beam computed tomography, which has emerged as a feasible and accurate low-dose alternative as compared to conventional computed tomography to detect destructive change, and magnetic resonance imaging which is considered the method of choice for assessing acute, inflammatory change, although the lack of normative standards remains a challenge in children.
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Affiliation(s)
| | - O Angenete
- Department of Radiology, St Olav University Hospital, Norway
| | - S Jellestad
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - N Tzaribachev
- Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - B Koos
- Department of Orthodontics, University of Rostock, Germany
| | - K Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; University of Bergen, Department of Clinical Medicine K1, Norway.
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Andersen K, Pedersen TK, Svendsen P, Hauge EM, Schou S, Nørholt SE. Effect of unilateral mandibular distraction osteogenesis on mandibular morphology in rabbits with antigen-induced temporomandibular joint arthritis. Int J Oral Maxillofac Surg 2015; 44:1052-9. [PMID: 25835759 DOI: 10.1016/j.ijom.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 01/03/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
Aim was to evaluate effect of unilateral distraction osteogenesis (DO) on mandibular morphology in rabbits with antigen-induced arthritis in the temporomandibular joint (TMJ). Forty 8-week-old rabbits were divided into four groups. In groups A,C, arthritis was induced in the right TMJ. Groups A,B underwent DO. Group D served as control group. Cephalometric analysis of mandibular angle, mandibular ramus height, mandibular collum height, and total posterior mandibular height was done on CT-scans preoperatively (T0), after distraction (T1), and at euthanasia (T2). Two-factor ANOVA evaluated the effect of DO and antigen-induced arthritis. No effect of DO or arthritis was observed on mandibular angle or mandibular collum height. For T0-T1, DO increased mandibular ramus height 12.3% (95% CI 5.2-19.4%) in group B (P=0.001) and total posterior mandibular height 6.2% (95% CI 0.3-12.1%) in group A (P=0.04) and 10.0% (95% CI 4.3-15.7%) in group B (P=0.001). For T1-T2, no significant changes occurred in arthritic rabbits (group A). In conclusion, DO increased total posterior mandibular height in rabbits with arthritis. Postoperatively, no significant effect of DO was observed in rabbits with arthritis. Mandibular DO could be a viable treatment modality in patients with TMJ-arthritis.
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Affiliation(s)
- K Andersen
- Section of Oral and Maxillofacial Surgery and Oral Pathology, Department of Dentistry, Aarhus University, Aarhus, Denmark.
| | - T K Pedersen
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark; Section of Orthodontics, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - P Svendsen
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - E M Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - S Schou
- Section of Oral and Maxillofacial Surgery and Oral Pathology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - S E Nørholt
- Section of Oral and Maxillofacial Surgery and Oral Pathology, Department of Dentistry, Aarhus University, Aarhus, Denmark; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
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Juvenile Idiopathic Arthritis of the Axial Joints: A Systematic Review of the Diagnostic Accuracy and Predictive Value of Conventional MRI. AJR Am J Roentgenol 2014; 202:199-210. [DOI: 10.2214/ajr.12.10475] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Stoustrup P, Kristensen KD, Verna C, Küseler A, Pedersen TK, Herlin T. Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic review on efficacy and safety. Semin Arthritis Rheum 2013; 43:63-70. [PMID: 23352251 DOI: 10.1016/j.semarthrit.2012.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the current level of evidence for the use of intra-articular corticosteroid injections (IACI) against temporomandibular joint (TMJ) arthritis in patients with juvenile idiopathic arthritis (JIA) with a particular focus on clinical and radiological improvements and safety profile. METHODS A comprehensive electronic search strategy was performed in all major medical databases in February 2012. Studies were selected independently by two reviewers in accordance with a pre-specified protocol and a risk of bias assessment for all included studies. RESULTS Ninety-four unique citations were identified of which seven remained after the inclusion criteria were applied and all of these were assessed to have a high risk of bias. The current limited level of evidence suggests potential beneficial properties of IACI in patients with TMJ arthritis-related symptoms and/or MRI-verified signs of TMJ inflammation. Currently, no scientific evidence substantiates the effect of IACI in terms of (I) improving maximal mouth opening capacity significantly, (II) reducing radiological disease progression, (III) normalising/improving mandibular growth, and (IV) increasing efficacy upon repeated injections. CONCLUSION The current level of evidence allows only very limited conclusions on the effect of IACI therapy in patients with TMJ arthritis. Knowledge on the long-term impact of IACI on mandibular growth is not available. Future studies designed in accordance with evidence-based standards are needed to allow a more general conclusion on efficacy and safety of this treatment modality in patients with TMJ arthritis.
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Affiliation(s)
- Peter Stoustrup
- Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, Aarhus C, Denmark.
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Juvenile idiopathic arthritis-and now?: a systematic literature review of changes in craniofacial morphology. J Orofac Orthop 2012; 73:265-76. [PMID: 22777168 DOI: 10.1007/s00056-012-0091-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 05/21/2012] [Indexed: 10/28/2022]
Abstract
AIM To conduct a systematic literature review on the impact of juvenile idiopathic arthritis (JIA) on craniofacial morphology. MATERIALS AND METHODS Several electronic databases (PubMed, Medpilot, Web of Science, DIMDI) were systematically searched for studies that were published up to and including May 2011. In addition, a manual search of the orthodontic and rheumatologic literature was conducted, and reference lists of the selected articles were checked for relevant publications. The identified articles were independently assessed by two investigators and selected according to a three-step process (title/abstract/full text). RESULTS After completion of the selection procedure, 19 articles were identified possessing great heterogeneity. In most of them, no differentiated analysis of the various JIA subtypes was performed, and type-specific analyses according to mandibular joint effects were seldom. Additional factors such as patient age, disease duration, medication, previous orthodontic treatment as well as the inclusion of a control group were also highly inhomogeneous, which made a meta-analysis of the data impossible. Nevertheless, it appears as if JIA patients tend to develop a hyperdivergent vertical jaw base relationship and a skeletal Class II pattern. CONCLUSION Due to the heterogeneous patient samples, it is currently not possible to draw a differentiated conclusion on the influence of various types of JIA on craniofacial morphology.
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Stoustrup P, Küseler A, Kristensen KD, Herlin T, Pedersen TK. Orthopaedic splint treatment can reduce mandibular asymmetry caused by unilateral temporomandibular involvement in juvenile idiopathic arthritis. Eur J Orthod 2011; 35:191-8. [PMID: 21969524 DOI: 10.1093/ejo/cjr116] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Peter Stoustrup
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Aarhus C, Denmark.
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von Bremen J, Ruf S. Orthodontic and dentofacial orthopedic management of juvenile idiopathic arthritis: a systematic review of the literature. Orthod Craniofac Res 2011; 14:107-15. [DOI: 10.1111/j.1601-6343.2011.01514.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Müller L, Kellenberger CJ, Cannizzaro E, Ettlin D, Schraner T, Bolt IB, Peltomäki T, Saurenmann RK. Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging. Rheumatology (Oxford) 2009; 48:680-5. [PMID: 19386819 PMCID: PMC2681286 DOI: 10.1093/rheumatology/kep068] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To study the validity of both rheumatological and orthodontic examinations and ultrasound (US) as screening methods for early diagnosis of TMJ arthritis against the gold standard MRI. METHODS Thirty consecutive juvenile idiopathic arthritis (JIA) patients were included in this pilot study. Rheumatological and orthodontic examinations as well as US were performed within 1 month of the MRI in a blinded fashion. Joint effusion and/or increased contrast enhancement of synovium or bone were considered signs of active arthritis on MRI. RESULTS A total of 19/30 (63%) patients and 33/60 (55%) joints had signs of TMJ involvement on MRI. This was associated with condylar deformity in 9/19 (47%) patients and 15/33 (45%) joints. Rheumatological, orthodontic and US examinations correctly diagnosed 11 (58%), 9 (47%) and 6 (33%) patients, respectively, with active TMJ arthritis, but misdiagnosed 8 (42%), 10 (53%) and 12 (67%) patients, respectively, as having no signs of inflammation. The best predictor for active arthritis on MRI was a reduced maximum mouth opening. CONCLUSION None of the methods tested was able to reliably predict the presence or absence of MRI-proven inflammation in the TMJ in our cohort of JIA patients. US was the least useful of all methods tested to exclude active TMJ arthritis.
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Affiliation(s)
- Lukas Müller
- Clinic for Orthodontics and Pediatric Dentistry, University of Zürich, Zürich, Switzerland
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Stoustrup P, Kristensen KD, Küseler A, Pedersen TK, Gelineck J, Herlin T. Intra-articular vs. systemic administration of etanercept in antigen-induced arthritis in the temporomandibular joint. Part II: mandibular growth. Pediatr Rheumatol Online J 2009; 7:6. [PMID: 19200378 PMCID: PMC2657784 DOI: 10.1186/1546-0096-7-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 02/06/2009] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) arthritis in children causes alterations in the craniomandibular growth. Resultant abnormalities include; condylar erosions, a posterior mandibular rotation pattern, micrognathia, malocclusion with an anterior open bite, altered joint and muscular function occasionally associated with pain. These alterations may be prevented by early aggressive anti-inflammatory intervention. Previously, we have shown that intra-articular (IA) corticosteroid reduces TMJ inflammation but causes additional mandibular growth inhibition in young rabbits. Local blockage of TNF-alpha may be an alternative treatment approach against TMJ involvement in juvenile idiopathic arthritis (JIA). We evaluated the anti-inflammatory effect of IA etanercept compared to subcutaneous etanercept in antigen-induced TMJ-arthritis in young rabbits in terms of mandibular growth. This article (Part II) presents the data and discussion on the effects on facial growth. In Part I the anti-inflammatory effects of systemic and IA etanercept administration are discussed. METHODS Arthritis was induced and maintained in the TMJs of 10-week old pre-sensitized rabbits (n = 42) by four repeated IA TMJ injections with ovalbumin, over a 12-week period. One group was treated weekly with systemic etanercept (0.8 mg/kg) (n = 14), another group (n = 14) received IA etanercept (0.1 mg/kg) bilaterally one week after induction of arthritis and one group (n = 14) served as an untreated arthritis group receiving IA TMJ saline injections. Head computerized tomographic scans were done before arthritis was induced and at the end of the study. Three small tantalum implants were inserted into the mandible, serving as stable landmarks for the super-impositions. Nineteen variables were evaluated in a mandibular growth analysis for inter-group differences. All data was evaluated blindedly. ANOVA and T-tests were applied for statistical evaluation using p < 0.05 as significance level. RESULTS Significant larger mandibular growth disturbances were observed in the group receiving IA saline injections compared with the systemic etanercept group. The most pronounced unfavourable posterior mandibular rotation pattern was observed in the group receiving IA saline injections. CONCLUSION Intervention with systemic etanercept monotherapy equivalent to the recommended human dose allows a mandibular growth towards an original morphology in experimental TMJ arthritis. Systemic administrations of etanercept are superior to IA TMJ administration of etanercept in maintaining mandibular vertical growth.
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Affiliation(s)
- Peter Stoustrup
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.
| | - Kasper D Kristensen
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
| | - Annelise Küseler
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
| | - Thomas K Pedersen
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
| | - John Gelineck
- Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital Skejby, Brendstrupgaardvej 100, 8200 Aarhus N, Denmark
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Sidiropoulou-Chatzigianni S, Papadopoulos MA, Kolokithas G. Mandibular Condyle Lesions in Children with Juvenile Idiopathic Arthritis. Cleft Palate Craniofac J 2008; 45:57-62. [DOI: 10.1597/07-014.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To assess the prevalence of radiographically detectable destruction of the temporomandibular joints in children with juvenile idiopathic arthritis and to study the possible relationships between condylar destruction and type and duration of the disease, as well as the type of occlusion. Material And Method: The study group consisted of 66 children with juvenile idiopathic arthritis (27 boys, 39 girls; mean age, 11.9 years). The possible presence of condylar destruction was examined in panoramic radiographs. The medical history and the type of malocclusion were registered also. The statistical evaluation was performed by means of descriptive statistics, Student's t test, Pearson's chi-square, and an analysis of variance test. The whole procedure was repeated after a 4-week interval to estimate the error of the method. Results: Of the children with juvenile idiopathic arthritis, 50% showed some form of condylar destruction. Significant correlation was found between the type of the disease and the condyles affected. In the polyarticular type of juvenile idiopathic arthritis, 75% of the children presented affected condyles and 55.6% of them showed lesions bilaterally. The condylar affection was found to be independent of sex, although girls showed a tendency to bilateral lesions. In children with unilateral destruction, the right condyle was affected four times more frequently than the left. The duration of juvenile idiopathic arthritis seems to be significantly correlated to condylar destruction and especially to bilateral destruction. Conclusion: Children with juvenile idiopathic arthritis presented a remarkable prevalence of condylar destruction, which was correlated to the type and duration of the disease.
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Affiliation(s)
| | - Moschos A. Papadopoulos
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Kolokithas
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ueeck BA, Mahmud NA, Myall RW. Dealing with the Effects of Juvenile Rheumatoid Arthritis in Growing Children. Oral Maxillofac Surg Clin North Am 2005; 17:467-73. [DOI: 10.1016/j.coms.2005.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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