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Linsen SS, Teschke M, Heim N, Mercuri LG. Is the risk of chronic pain after total temporomandibular joint replacement independent of its indications? A prospective cohort study. Br J Oral Maxillofac Surg 2023; 61:337-343. [PMID: 37230824 DOI: 10.1016/j.bjoms.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up. The predictor variables were objective pressure pain thresholds (PPTs) at the ipsilateral joint(s) and muscle(s), functional parameters (incisal range of motion, maximum voluntary clenching), subjective oral health-related quality of life (OHRQoL), and demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 preoperatively to 10 at follow up. Self-reported TMJ pain was significantly reduced in the entire group (p = 0.001). Patients with moderate/severe pain at follow up were more restricted in their OHRQoL but did not differ in PPT and functional parameters from the no/mild pain group. Moderate/severe TMJ pain at follow up was associated with unilateral TMJR and more preoperative pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common and, in rare cases, may even worsen regardless of the original diagnosis. At follow up there was a close relation between OHRQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).
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Affiliation(s)
- S S Linsen
- Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany.
| | - M Teschke
- Private Practice, Zeppelinstr.24, 61352 Bad Homburg, Germany
| | - N Heim
- Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - L G Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States; Department of Bioengineering, University of Illinois Chicago, 851 S Morgan St, Chicago, IL 60607, United States; Stryker/TMJ Concepts, 6059 King Drive, Ventura, CA 93003, United States
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Linsen SS, Schön A, Teschke M, Mercuri LG. Does Maximum Voluntary Clenching Force Pose a Risk to Overloading Alloplastic Temporomandibular Joint Replacement?-A Prospective Cohort Study. J Oral Maxillofac Surg 2021; 79:2433-2443. [PMID: 34280358 DOI: 10.1016/j.joms.2021.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The amount of maximum voluntary clenching (MVC) force may influence functional loading at the polyethylene/metal bearing surfaces in alloplastic total temporomandibular joint replacement (TMJR). The aim of this study was to measure ipsilateral MVC and estimate the risk for revision due to overloading of the TMJR. METHODS A prospective cohort study design was used to study patients who underwent alloplastic TMJR. The primary predictor was time after TMJR, the secondary predictors were age at TMJR placement, coronoidectomy, prior ipsilateral TMJ surgeries, TMJR design (custom, stock), and bite location. The primary outcome variable was MVC, the secondary outcome was need for TMJR revision. Data were collected preoperatively (T0), and 1 year (T1), 2 to 3 years (T2) and ≥4 years postoperatively (T3). Analysis of variance (ANOVA) with post hoc Tukey-HSD and regression analysis was used for statistical analysis. P < .05 was considered significant. RESULTS Thirty-seven patients (58 TMJR) with unilateral (n = 16) and bilateral (n = 21) TMJR were enrolled; 8 males (12 TMJR) and 29 females (46 TMJR). Average age was 46.4 ± 14.9 years. MVC increased significantly over the observation period (P = .000). At all observation time points, age at TMJR placement and bite location significantly influenced MVC (P = .000). Coronoidectomy and prior ipsilateral TMJ surgeries did not demonstrate a significant influence on MVC. TMJR design influenced MVC significantly at T3 (P = .006). Regression analysis identified age as a significant factor for higher MVC. No TMJR required revision or replacement. CONCLUSIONS Based on this study, ipsilateral MVC increases significantly after TMJR. However, since MVC is significantly lower than in healthy test-patients, a considerably lower functional loading at the polyethylene/metal bearing surfaces can be assumed. Lower loading at the TMJR bearing surfaces and at the cortical screw fixation sites suggest a potential longer lifespan compared to other artificial joints like hip and knee prostheses.
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Affiliation(s)
- Sabine S Linsen
- Priv.-Doz., Dr. med. dent., MSc, Assistant Professor, Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Bonn, Germany.
| | - Andreas Schön
- Dr. med., Dr. med. dent., Assistant Professor, Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Marcus Teschke
- Dr. med., Dr. med. dent., Private Practice, Praxis fuer Gesichtschirurgie und Kiefergelenkschirurgie, Hamburg, Germany
| | - Louis G Mercuri
- Visiting Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, Chicago, IL; Clinical Consultant, TMJ Concepts, Ventura, CA
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Linsen SS, Schön A, Mercuri LG, Teschke M. How Does a Unilateral Temporomandibular Joint Replacement Affect Bilateral Masseter and Temporalis Muscle Activity?—A Prospective Study. J Oral Maxillofac Surg 2021; 79:314-323. [DOI: 10.1016/j.joms.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
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Linsen SS, Schön A, Mercuri LG, Teschke M. Unilateral, Alloplastic Temporomandibular Joint Reconstruction, Biomechanically What Happens to the Contralateral Temporomandibular Joint?-A Prospective Cohort Study. J Oral Maxillofac Surg 2021; 79:2016-2029. [PMID: 33631133 DOI: 10.1016/j.joms.2021.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Unilateral alloplastic total temporomandibular joint reconstruction (TMJR) might influence the contralateral side joint function. This study's purpose was to estimate the risk for contralateral TMJR and the jaw function of the contralateral untreated temporomandibular joint (TMJ). PATIENTS AND METHODS A prospective cohort study design was used for patients who underwent unilateral alloplastic TMJR. The primary predictor was time after TMJR, and the secondary predictors were pre-TMJR mandibular angle resection, prior ipsilateral TMJ surgeries, and TMJR design (custom, stock). The primary outcome variable was the need for contralateral TMJR. The secondary outcome variables were the results of jaw function-jaw tracking, maximum voluntary clenching, surface electromyography, and pressure pain thresholds (PPT) and patient's quality-of-life (oral health-related quality-of-life [OHrQoL]). Data were collected preoperatively (T0), and 1 year (T1), 2-3 years (T2), and ≥ 4 years postoperatively (T4). Analysis of variance with post hoc Tukey -HSD test and multiple linear regression analysis were used for statistical analysis. P < .05 was considered significant. RESULTS Thirty-nine patients were enrolled, 15 males and 24 females, with an average age of 48.9 ± 16.2 years. Two patients (5.1%) required a contralateral TMJR. Contralateral condylar motion, incisal laterotrusion, and protrusion slightly decreased, while incisal opening (P = .003), rotation angle (P = .013), opening deflection, surface electromyography activity, maximum voluntary clenching (P = .01), PPTs, and OHrQoL all increased. Pre-TMJR mandibular angle resection had an impact on PPTs and subjective outcomes and prior ipsilateral TMJ surgeries on the opening rotation angle. CONCLUSIONS Based on this study, bilateral TMJR does not appear necessary when the contralateral TMJ is healthy. Unilateral alloplastic TMJR is associated with improved contralateral jaw function and OHrQoL.
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Affiliation(s)
- Sabine S Linsen
- Assistant Professor, Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Bonn, Germany.
| | - Andreas Schön
- Assistant Professor, Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Bonn, Germany
| | - Louis G Mercuri
- Visiting Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, Chicago, IL; and Clinical Consultant, TMJ Concepts, Ventura, CA
| | - Marcus Teschke
- Private Practice, Praxis fuer Gesichtschirurgie und Kiefergelenkschirurgie, Hamburg, Germany
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Linsen SS, Gellrich NC, Krüskemper G. Age- and localization-dependent functional and psychosocial impairments and health related quality of life six months after OSCC therapy. Oral Oncol 2018; 81:61-68. [DOI: 10.1016/j.oraloncology.2018.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 12/22/2022]
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Linsen SS, Wolf M, Müßig D. Long-term outcomes of mandibular kinematics following class II malocclusion therapy with removable functional appliance therapy. Cranio 2016; 34:363-370. [DOI: 10.1080/08869634.2015.1133005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Linsen SS, Stark H, Klitzschmüller M. Reproducibility of condyle position and influence of splint therapy on different registration techniques in asymptomatic volunteers. Cranio 2013; 31:32-9. [PMID: 23461260 DOI: 10.1179/crn.2013.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The current study aims to analyze and quantify the effects of different registration techniques on the reproducibility of condyle position and the influence of stabilization splint therapy on the technique's reproducibility. Three-dimensional electronic-condylar-position analysis (EPA) with an ultrasound-based jaw-tracking system was recorded during intermaxillary registration of manually guided centric relation (CR), maximal intercuspation (MI), and clenching-force-dependent Gothic arch tracing guided centric relation (DIR method) before (T0) and after (T1) splint therapy. Patients were supplied with a stabilization splint for three months on the basis of the DIR registration. Participants were 26 asymptomatic volunteers with a mean age of 30.6 +/- 9.5 years. The registration technique was found to have a significant (p = 0.001) effect on condylar displacement in all axes before, and in X- and Y-axes after splint therapy. Condyles during DIR were found to be in a more anterior-inferior position compared with CR and MI, with the condyles in the latter position being likewise more anterior than in CR. There were significant (p < 0.03) differences in reproducibility of the condyle position dependent on the technique, both at T0 and T1. The DIR method showed the highest reproducibility, followed by MI and CR. There was no significant effect of time of investigation on the technique's reproducibility.
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Affiliation(s)
- Sabine S Linsen
- University of Bonn, Welschnonnenstr. 17, D-53111 Bonn, Germany.
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Linsen SS, Reich RH, Teschke M. Pressure Pain Threshold and Oral Health-Related Quality of Life Implications of Patients With Alloplastic Temporomandibular Joint Replacement—A Prospective Study. J Oral Maxillofac Surg 2012; 70:2531-42. [DOI: 10.1016/j.joms.2012.06.193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/28/2012] [Accepted: 06/29/2012] [Indexed: 11/24/2022]
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Linsen SS, Reich RH, Teschke M. Mandibular Kinematics in Patients With Alloplastic Total Temporomandibular Joint Replacement—A Prospective Study. J Oral Maxillofac Surg 2012; 70:2057-64. [DOI: 10.1016/j.joms.2012.05.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 05/20/2012] [Accepted: 05/24/2012] [Indexed: 11/26/2022]
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Linsen SS, Stark H, Matthias A. Changes in condylar position using different types of splints with and without a chinstrap: a case-control study. Cranio 2012; 30:25-31. [PMID: 22435174 DOI: 10.1179/crn.2012.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this case-control study was to analyze and quantify if there is a different mechanical effect of stabilization and pivot splints with uni- or bilateral pivot of different heights and with and without an additional chinstrap, on the vertical, sagittal, and horizontal condyle position. A stabilization splint and splints with unilateral or bilateral posterior pivot support of 0.6 mm or 1.9 mm height were used with and without a chinstrap individually adjusted to 5N per side. Electronic-condylar-position-analysis was performed using an ultrasound-based jaw-tracking system with an accuracy of 0.1 mm. Manual guided central position served as the reference point. Participants were 40 functional, asymptomatic volunteers with a mean age of 33.9 years. Main effect splint design (stabilization, uni-, bilateral pivot) was not significant. Pivoting height was reported as significant (p < or = 0.02) in all axes. Use of the chinstrap was significant (p < or = 0.03) in the X- and Y- axis, but not significant in the Z-axis. A post-hoc test revealed that use of a chinstrap led to significantly (p = 0.003) less anterior and significantly (p = 0.002) more inferior condyle displacement. Results indicate that the use of pivot splints only in combination with a chinstrap lead to a distractive effect of the condyles.
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Affiliation(s)
- Sabine S Linsen
- Department of Prosthodontics, Preclinical Education and Dental Materials Science of Bonn Medical School, Germany.
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Linsen SS, Martini M, Stark H. Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy. Clin Implant Dent Relat Res 2009; 14:250-8. [PMID: 19843104 DOI: 10.1111/j.1708-8208.2009.00248.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to analyze the long-term survival of implants and implant-retained prostheses in patients after ablative surgery of oral cancer with or without adjunctive radiation therapy. MATERIALS AND METHODS Between 1997 and 2008, 66 patients who had undergone ablative tumor surgery in the oral cavity were treated with dental implants (n = 262). Thirty-four patients received radiation therapy in daily fractions of 2 Gy administered on 18 to 30 days. Implants were inserted in the maxilla (49; 18.7%) or mandible (213; 81.3%), in non-irradiated residual (65; 24.8%) or grafted bone (44; 16.8%) and in irradiated residual (15.6%) or grafted bone (39; 14.9%). Seventeen fixed protheses and 53 removable dentures (34 bar attachments, 9 telescopic and 10 ball retained dentures) were inserted. RESULTS Mean follow-up after implant insertion was 47.99 (±34.31) months (range 12-140 months). The overall 1-, 5-, and 10-year survival rates of all implants were 96.6%, 96.6%, and 86.9%, respectively. Fourteen implants were lost in nine patients (5.3% of all implants); eight implants were primary losses, and five secondary losses because of an operation of tumor recurrence. There was no significantly lower implant survival for implants inserted into irradiated bone (p = .302), bone and/or soft-tissue grafts (p = .436), and maxilla or mandible (p = .563). All prosthetic restorations in patients without tumor recurrence could be maintained during the observation period. CONCLUSIONS Implant survival is not significantly influenced by radiation therapy, grafts (bone and/or soft tissue), or location (maxilla or mandible). However, implants placed in irradiated bone exhibit a higher failure rate during the healing period than those placed in non-irradiated bone. No superstructure was particularly favorable. Osseointegrated implants can be used successfully in patients with prior history of ablative surgery with and without additional radiation therapy.
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Affiliation(s)
- Sabine S Linsen
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Rheinische Friedrich-Wilhelms University of Bonn, Bonn, Germany.
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Linsen SS, Wirtz D, Fischer C, Koeck B. Optimization of the marginal gap of all-ceramic restorations and gold crowns by ultrasound activated, suspended Al2O3 powder. Am J Dent 2009; 22:255-258. [PMID: 20225465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To evaluate if the use of ultrasound activated Al203 powder improved the fit especially of all-ceramic restorations. METHODS 21 extracted teeth were prepared for 14 all-ceramic IPS Empress2 (IPS Empress2) restorations (four crowns, four partial crowns, two inlays, four veneers) and seven gold crowns (Degudent H). Each restoration was adjusted with a suspension of Al2O3 of 25 microm and 50 microm grit, respectively. The effect of the fitting adjustments was recorded with the silicone disclosing medium technique and measured at 11 points under the microscope in an interval of 0.4 mm. RESULTS A significant (P < 0.001) improvement of the tight fit of all restorations by means of ultrasound activated Al2O3 powder was noticed. The approach of the restoration towards the prepared stump by the sonoerosive fitting correction was in the mean 201 +/- 60 microm in Empress2 restorations and 87 +/- 24 microm in gold crowns within a period of 10 minutes. SEM observation of the Empress2 specimens showed no microdamage after ultrasound machining.
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Affiliation(s)
- Sabine S Linsen
- Department of Prosthodontics, University of Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany.
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