Mandibular changes after total joint replacement in patients with adolescent internal condylar resorption
Rajaei, Ahmadreza Arash
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Background: Adolescent internal condylar resorption (AICR), formerly known as Idiopathic Condylar Resorption (ICR), is a specific condition that affects the temporomandibular joints, most commonly in teenage females, occurring with a 9:1 female:male ratio. The resorption rarely develops after the age of 20 and, although well documented, is a poorly understood disease. AICR affects the mandibular condyle and can create occlusal and musculoskeletal instability, resulting in the development of dentofacial deformities, temporomandibular joint (TMJ) dysfunction and pain. Factors that increase susceptibility to AICR include female sex, age range from 10 to 20 years, with a strong predilection for teenagers in their pubertal growth phase, high occlusal and mandibular plane angles and class II skeletal and occlusal relationships, with or without open bite. Materials and Methods: Retrospectively, 25 patients who had been diagnosed with AICR and had had total joint prostheses placed were evaluated for skeletal stability, mandibular function and pain. Measurements from immediate postoperative and longest available follow-up were compared. Cephalometric radiographs were used to measure changes in the jaws vertically and horizontally. Changes in the occlusal plane, SNA, SNB, the mandibular plane angle (MPA), total mandibuIar length (Go-Gn), palatal plane angle and gonial angle were evaluated to deter-mine skeletal stability. Visual analog scales evaluated changes in levels of pain and jaw function. Maximum interincisal opening and lateral excursive movements were compared between time points. Results: The average postoperative follow-up time was 15 months with a range from 7-37 months. At the longest follow-up the occlusal plane, palatal plane, SNA, SNB and Go-Gn showed insignificant change relative to the immediate postoperative timepoint. At the longest follow-up, the MPA increased by 1.0 degrees ([plus or minus] 1.5; range -5.1 to 2.1) and the gonial angle increased by 1.2 degrees ([plus or minus] 1.9; range -6.4 to 1.3 degrees). Although both values were statistically significant (p[less than] 0.005), neither was clinically significant. Postoperatively, the maximum interincisal opening increased by an average of 4.1mm ([plus or minus] 5.3; range -4 to 20 mm) but lateral excursive movements decreased significantly, as was expected due to the nature of the prosthesis. All patients reported an improvement in function; however, 2 patients reported no improvement in pain. Conclusion: Total joint replacement used in the treatment of patients with AICR has been shown to result in skeletal stability and improve function and pain levels in the large majority of patients.
PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact email@example.com.Thesis (MSD) --Boston University, Henry M. Goldman School of Dental Medicine, 2013 (Department of Orthodontics and Dentofacial Orthopedics).Includes bibliographic references: leaves 33-34.
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