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Biomedical subjects

G Widmark

Publications and source records attributed to G Widmark.

At least 19 recordsLinked to original sources
PubMed1997

Mandibular bone graft in the anterior maxilla for single-tooth implants. Presentation of surgical method.

Nine patients with 10 implants were included in the study. A bone graft from the symphyseal region of the mandible was used to augment the ridge 4 months before implant insertion. All implant sites showed a sufficient amount of bone at the time of implant insertion. One implant was not integrated at the time of abutment connection. Bone resorption after augmentation was assessed by measurements of the width of the alveolar ridge at four different levels. The measurements were performed before and after the bone-grafting procedure, at implant insertion and at abutment connection. The bone resorption in the buccal/palatal direction was 60% when measured from the time of bone grafting to abutment connection. The bone resorption was already obvious after 4 months (25%). The results indicate that the described bone grafting technique is applicable in patients with a narrow alveolar ridge, even though the resorption of the graft was extensive.

Adolescent↗
PubMed1997

Diskectomy in temporomandibular joints with internal derangement: a follow-up study.

OBJECTIVE: To follow up a series of patients treated consecutively who had undergone a diskectomy 2 years previously because of persistent pain and disk displacement in the temporomandibular joint. STUDY DESIGN: Sixteen subjects rated their current symptoms during 1 week and were systematically examined for signs of temporomandibular disorders clinically and radiographically by independent observers. RESULTS: Subjectively, all subjects were satisfied with the operation. Five rated their current pain as significant during masticatory function. Some signs of temporomandibular disorders, usually related to function, were registered in all subjects. Postoperative mandibular movements were improved but still below normal range. Signs and symptoms correlated significantly. Surgical complications were nonexistent, but radiographic changes were extensive. Erosion and flattening of the condyle were common. CONCLUSIONS: It was verified that subjects with persistent pain and disk displacement benefit subjectively and clinically from diskectomy. The radiographic outcomes appear less encouraging. Only prospective, randomized, and controlled studies can eventually clarify the effectiveness of diskectomy in relieving pain caused by displacements in the temporomandibular joint.

Adult↗
PubMed1997

Management of chronic orofacial pain: attitudes among patients and dentists in a Swedish county.

The purpose was to survey attitudes towards management of chronic orofacial pain (COP). Questionnaires were mailed to 30 randomized dentists and to 30 consecutive COP patients, examined 16 months earlier by a pain group of dental specialists. Fifty-seven per cent of the patients reported that their pain was the same as or worse than before and was disturbing. Few were dissatisfied with the examinations. Fifty-nine per cent thought that the consultations had been good. The surveyed dentists judged the most common causes of COP to be neurogenic and psychogenic in origin; they were overwhelmingly positive to the idea of a pain group (93%) and could consider referring patients (97%). Pain-inducing local diseases occurred but were not dominant among these COP patients. We concluded that management of COP in a pain group appears to be meaningful, as reflected by the respondents' attitudes but would gain by a closer collaboration with medical expertise.

Adult↗
PubMed1997

On surgical intervention in the temporomandibular joint.

The aim of this thesis was to evaluate the indications for and the results of temporomandibular joint (TMJ) surgery in patients with long-standing severe orofacial pain and dysfunction as well as in patients with fractures of the condylar neck. The patients with long-standing pain and dysfunction had had symptoms for a mean time of 4 years, had been treated conservatively for a mean time of 2.5 years, and had undergone numerous conservative treatment methods without improvement except for a minor increase in mouth opening capacity. The indications for surgery were strict; only 1% or less of all the patients referred to the departments with a diagnosis of temporomandibular disorder (TMD) were prescribed surgery, which was considered to be the only remaining option. The TMJ surgery reduced pain, sleeping problems, and analgesic consumption and improved mouth opening capacity. The procedure showed low morbidity except for a facial nerve disturbance in three patients. Postoperatively, the bite force was observed to be normalised, and the radiographic examination showed moderate to severe osteoarthrotic changes. These changes, though extensive, were considered to be the normal outcome of diskectomy and without clinical significance, even though they resembled degenerative joint disease. In study V, surgery was performed on patients with a clear diagnosis of anterior disk displacement (ADD) with or without reduction. The preoperative pain and mouth opening capacity were markedly improved as well as other subjective symptoms. Although surgical morbidity was low, some radiographic changes were clearly detectable. In agreement with earlier reports, patients with a distinct diagnosis of ADD with or without reduction were clearly helped by diskectomy. In cases of ADD with or without reduction, it can be concluded that unsuccessful conservative treatment should not exceed 3-6 months but be discontinued in favour of the documented advantages of surgery in these cases. Patients with ankylosis should be treated surgically without delay. Unclear diagnoses such as arthralgia and osteoarthrosis with symptoms should be excluded from surgery unless overlapping muscular hyperactivity has been excluded as a major cause of the patients problem. Diskectomy is a useful surgical procedure for patients with severe long-standing TMD. It was shown in study VI that patients with dislocated fractures of the condylar neck can be successfully treated with open surgical reduction when the dislocation is large and associated with symptoms and limited function. When cognitive-behavioural profiles were measured psychometrically in study VII, a dysfunctional profile was more common in patients with myofascial pain and pain with an obscure origin than in other patients diagnosed with TMD. The dysfunctional profile was also common in patients in whom treatment of a conservative or surgical nature had failed. Among TMD patients with disk displacement, adaptive copers were most common in successfully diskectomized patients and least common in patients about to undergo invasive treatment.

Adaptation, Psychological↗
PubMed1996

Open reduction of subcondylar fractures. A study of functional rehabilitation.

Open reduction of dislocated subcondylar fractures was carried out in 19 adult patients between 1990 and 1992. A comparison of the results between two groups of patients was made 1 year after trauma. The reference group consisted of patients with the same type of fracture but treated with only intermaxillary fixation (IMF) and moderate jaw exercises after release of IMF. Dysfunction of the masticatory system was noticed in only a few cases of either group. Open reduction with plate osteosynthesis made it possible to avoid IMF in 12 of 19 patients. The results in the two groups did not differ significantly from a functional point of view. There are, however, specific indications for open reduction based on the degree of dislocation and concomitant subjective symptoms.

Adolescent↗
PubMed1996

Radiographic morphology in the temporomandibular joint after diskectomy.

The purpose of the study was to evaluate the radiographic appearance in the temporomandibular joint after diskectomy in patients refractory to conservative treatment. The diskectomies were performed in patients in which the common diagnosis were internal derangement or symptoms of osteoarthrosis. Postoperative radiographs were taken in 25 patients after 1-17 yrs and compared with the preoperative from both the operated and the nonoperated joints. Moderate to severe osteoarthrotic changes were found on the operated side in all but two patients in contrast to on the nonoperated side where such changes were absent in all patients except in one who had minor to moderate changes. The radiographic examinations showed flattening of the condylar head but also irregularities and bone apposition. In almost all patients the fossa showed a sclerotic surface, flattening but only occasionally bone apposition and irregularities. Sclerotic changes were found in about 50% of the patients but erosions only rarely. Similar postsurgical changes were also seen on the articular eminence. A reduced joint space was seen in 18 patients. The postsurgical radiographic changes are the normal out come of diskectomy and do not have clinical significance even though they resemble degenerative joint disease.

Adult↗
PubMed1995

Evaluation of TMJ surgery in cases not responding to conservative treatment.

The aim of the study was to evaluate the treatment outcome after temporomandibular joint (TMJ) surgery, which was performed in 33 patients (27 women and six men) between 1970 and 1986. Before surgery, the patients received different types of conservative treatment for an average time of 29 months. The most common diagnosis was anterior disk displacement (ADD) with or without reduction (n = 10), followed by unspecified arthralgia (n = 8), osteoarthrosis (n = 7) and ankylosis (n = 4). Standardized clinical records served as the basis for comparison of symptomatology at comparable time points. Furthermore, 31 of the 33 patients were subjected to a clinical follow-up, including anamnestic, clinical, radiological and cast analysis, 2-17 years after operation. Pain, sleeping problems and consumption of analgesics were significantly reduced after surgery. The anamnestic, as well as the clinical dysfunction indices, according to Helkimo, were also significantly reduced. TMJ clicking was reduced, but crepitations increased in number. The best improvements were seen in patients with ADD without reduction and in patients with ankylosis.

Ankylosis↗
PubMed1995

Functional evaluation after TMJ surgery.

Oral function was evaluated in 30 patients (25 women and five men) after TMJ surgery by means of bite force measurements. Twenty-seven discectomies and three condylectomies had been performed. The follow-up period was, on average, 2.5 years. The mean bite force values on the function level 'biting as when chewing' was for the whole group 125.3 N on the right side and 128.8 N on the left side. The maximal bite force was on average 362.5 N and maximal endurance time on average 32 s. All test results showed big ranges. No significant differences between right and left side or operated and non-operated side could be found on the tested function level 'biting as when chewing'. The found bite force values were high in comparison with another similar study. The results were also compared with another group of patients (n = 6) who were examined before and 6 months after surgery. As far as bite force reflects oral function the results are indeed very encouraging.

Bite Force↗
PubMed1994

Correction of open bite by maxillary osteotomy. A comparison between bone plate and wire fixation.

A clinical and cephalometric standardized study of surgical correction of open bite deformity was performed on 19 individuals. The mode of fixation of the maxilla after surgical correction was by direct wires in 9 of the patients combined with suspension wires to the infraorbital rim and in 10 patients plate fixation. The follow-up time was 18 months and the results in both groups were clinically and cephalometrically stable in the short (2 and 6 months) and medium terms (18 months). No statistically significant difference was found between the groups regarding tendency to relapse. It was, however, concluded that the advantages of plate fixation both on clinical grounds and for patient comfort are factors in favour of using miniplates for maxillary surgical procedures.

Adolescent↗
PubMed1994

Effects of conservative treatment in patients who later will be candidates for TMJ surgery.

In an attempt to evaluate the effect of conservative treatment in 33 patients with longstanding symptoms from the joint and later subjected to temporomandibular joint surgery, a retrospective study was made based on careful case records and personal follow-up. The treatment period varied widely between the patients but was on average 2.5 years. The result of the conservative treatment in these patients was, however, very slight and limited to a minor increase in mouth-opening capacity. All TMJ-patients, including those with the diagnosis ADD and suspected ankylosis, ought to have a strict treatment and follow-up programme in order to reduce doctor's delay if and when surgical intervention should be necessary. Efforts should be focused on development of diagnostic methods to support the selection of patients for TMJ surgery earlier so as to avoid prolonged unsuccessful conservative treatment.

Adolescent↗
PubMed1993

Anterior tooth replacement with implants in patients with a narrow alveolar ridge form. A clinical study using guided tissue regeneration.

Clinical and radiographic examination was used to select patients with a suspected need of guided tissue regeneration (GTR). Fifteen patients with 20 fixtures were included in the study. Nine (45%) of the fixtures were completely covered with bone at fixture surgery and no GTR was required in these cases. On the remaining 11 fixtures, one or more sites were exposed and thus an expanded polytetrafluoroethylene membrane was used. The regenerative results were assessed using 2 methods, a) calculation of exposed threads in the mouth and on projected colour slides, b) photometric evaluation of exposed area. In total, the membrane group showed a bone gain of 81% when threads were calculated. Almost complete agreement in percentage of bone gain was observed between buccal (80.7%) and lingual (82.6%) sites. Photometric evaluation for the buccal sites showed a bone gain of 74%. Complete bone regeneration (100%) was achieved when healing was free from complications and also under an exposed membrane when infection was absent. The results indicate that the membrane technique is highly successful for treatment of exposed implants when healing is free from complications. It also shows that clinical and radiographic examination is not precise enough to differentiate between those patients planned for routine fixture surgery and those with a supplementary need for GTR. Thus access to GTR technique is important when treatment is planned for borderline cases.

Adolescent↗
PubMed1992

The use of a bone lid to close the anterior wall defect after surgery in the maxillary sinus.

Surgery was performed in the maxillary sinus with restoration of the surgical defect in the anterior wall with a resutured bone-lid, in 12 patients with an average age of 45 years, the technique is described and evaluated clinically and radiographically (computed tomography). During the followup time of 1-4 years, the condition of the maxillary sinus was normalized. It is our opinion that the bone-lid technique for maxillary sinus surgery is useful, especially when good overview and access is necessary.

Adult↗
PubMed1991

Use of miniplates in the treatment of jaw fractures.

The use of miniplate-osteosynthesis in fracture treatment has been evaluated in 47 patients. In 25 of the patients plate fixation of the fracture was used without intermaxillary fixation and in 22 a supplementary IMF was used. Nine of the 47 patients had alcohol or drug addiction problems. The most common cause of fracture was assault and traffic accidents. The rate of complications including sensibility disturbances, occlusal disturbance and infection was evenly distributed among the two groups. The frequency of postoperative sensibility disturbances was however high, fifteen of the patients, although the sensibility returned in seven of these patients. Postoperative infections developed in five patients where the time between trauma and treatment exceeded three days. In no single case did the plate insertion make any damage to adjacent teeth.

Adult↗
PubMed1989

Osteoradionecrosis of the jaws.

In 431 patients treated for malignant tumors 21 osteoradionecroses (ORN) were diagnosed in 19 patients. The relation of ORN to radiotherapeutic factors and surgical as well as extraction schemes were studied. There was a clear relation to high dose, high CRE and superfraction. Six ORN developed in connection with tooth extraction. The importance of atraumatic extraction is stressed.

Aged↗
PubMed1988

Surgical treatment of the open bite deformity. Surgical correction of combined mandibular prognathism and open bite by oblique sliding osteotomy of the mandibular rami.

Treatment of open bite deformity combined with a prognathic mandible using the oblique, sliding osteotomy of the mandibular rami has been followed for 2 1/2 years to evaluate the final outcome of the operation. The clinical and radiographic examination during the control period show a remarkably stable result with a relapse magnitude the same or slightly less than that for a straight, set-back procedure. A certain dental compensation occurs during the skeletal relapse. The thought of creating a certain "freedom-space" in the muscular fibres during the set-back procedure, thus facilitating closure of the open bite is proposed. Surgical correction of the anterior open bite today is otherwise most frequently focused on solutions with maxillary le Fort I or subapical procedures to ensure minimal influence from the jaw muscles.

Cephalometry↗
PubMed1975

Separation of fresh tobacco smoke on a packed polar gas chromatographic column prior to on-line analysis by gas chromatography-mass spectrometry using a non-polar capillary column.

Gaseous samples of fresh tobacco smoke were injected on to a packed polar column (2,2-oxydipropionitrile) in all-glass chromatographic system. With the aid of a warm syringe, selected fractions were withdrawn from the bottom of the electron capture detector of the packed column for further injection into an efficient non-polar glass capillary column (SF-96), connectable on-line to a mass spectrometer. The method has permitted the separation and identification of some polar and non-polar components of tobacco smoke, which gave previously mixed, broad, tailing peaks when the smoke was injected directly into a non-polar capillary column.

Chromatography, Gas↗