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Aims: To study the relationship between generalized joint hyper-mobility (GJH) and temporomandibular disorders (TMD) by assessing prevalence and patient characteristics of TMD in a population of patients with maximum expression of GJH as a symptom of inherited connective tissue disease. In addition, diagnostic reliability of a series of clinical signs indicative of temporomandibular joint (TMJ) hypermobility was tested. Methods: The study sample consisted of 42 subjects with GJH, 24 with Marfan syndrome and 18 with Ehlers-Danlos syndrome. A subgroup of 27 individuals was selected by age (≤ 18 yrs) and was compared to 40 controls with TMD and normal peripheral joint mobility. TMD diagnoses were assigned to each subject according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Results: In the GJH sample (n = 42), 71.4% of the subjects were symptomatic for TMD. Of those, 13.3% had sought treatment. A myofascial pain diagnosis was made in 69%, disc dislocation with reduction was diagnosed in 85.7%, and TMJ arthralgia in 61.9%. Multiple TMD diagnoses were assigned in 69% of the subjects; of these, 57% had 3 or more subgroup diagnoses. Joint noises (P < .01) and recurrent TMJ dislocations (P < .01) were a frequent finding in adult GJH subjects (n = 27) compared to controls, with symptomatic GJH subjects presenting more and more prolonged dislocation events than asymptomatic subjects (P < .001). TMJ hypermobility signs were expressed significantly more often in GJH compared to controls with TMD and normal joint mobility. Conclusion: This study indicates a positive relationship between GJH and TMD. [ABSTRACT FROM AUTHOR]

The efficacy of grafting materials for alveolar bone regeneration procedures has been repeatedly corroborated by clinical and scientific evidence. Although an ever growing number of biomaterials are available on the market, the origins, material characteristics, bioactivity and osteoconductive properties of these products are not always known by clinicians, hence often hampering an adequate product selection. The purpose of this contribution was to provide an overview of five different types of osteoconductive grafting materials frequently used in dentistry (Bio-Oss®, Cerasorb M™, Bone Ceramic®, Natix®, Genos®) and to summarize their physico-chemical and morphological characteristics at the macro- and micro-scale. Furthermore, the influence of these properties on the in vivo behaviour of these biomaterials is discussed. The results of this study are presented as data sheets, which may prove helpful for clinicians in the design of their treatment strategies. [ABSTRACT FROM AUTHOR]

Mutations in the genes encoding fibrillin, an extracellular matrix protein involved in providing elastic properties to the connective tissues, may result in specific craniofacial and oral anomalies. A number of craniofacial (retrognathia, dolichocephaly, high palate) and dental (root deformity, pulp calcification) manifestations are considered pathognomic for the Marfan syndrome (MFS), a condition caused by congenital fibrillin-1 deficiency. Reports on similar features in congenital contractural arachnodactyly (CCA), caused by fibrillin-2 deficiency, support the hypothesis that fibrillin deficiency might result in a number of morphological anomalies by influencing tissue interaction during growth and development. Hence, clinical manifestations can be related to specific aspects of fibrillin deficiency pathogenesis, and may be adopted as diagnostic tools in the outlook for affected individuals. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor focusing on congenital contractual arachnodactyly.

Light and heat increase the reactivity of hydrogen peroxide. There is no evidence that light activation (power bleaching with high-intensity light) results in a more effective bleaching with a longer lasting effect with high concentrated hydrogen peroxide bleaching gels. Laser light differs from conventional light as it requires a laser-target interaction. The interaction takes place in the first instance in the bleaching gel. The second interaction has to be induced in the tooth, more specifically in the dentine. There is evidence that interaction exists with the bleaching gel: photothermal, photocatalytical, and photochemical interactions are described. The reactivity of the gel is increased by adding photocatalyst of photosensitizers. Direct and effective photobleaching, that is, a direct interaction with the colour molecules in the dentine, however, is only possible with the argon (488 and 415 nm) and KTP laser (532 nm). A number of risks have been described such as heat generation. Nd:YAG and especially high power diode lasers present a risk with intrapulpal temperature elevation up to 22°C. Hypersensitivity is regularly encountered, being it of temporary occurrence except for a number of diode wavelengths and the Nd:YAG. The tooth surface remains intact after laser bleaching. At present, KTP laser is the most efficient dental bleaching wavelength.

The use of optical radiation for the activation of bleaching products has not yet been completely elucidated. Laser light is suggested to enhance the oxidizing effect of hydrogen peroxide. Different methods of enhancing hydrogen peroxide based bleaching are possible. They can be classified into six groups: alkaline pH environment, thermal enhancement and photothermal effect, photooxidation effect and direct photobleaching, photolysis effect and photodissociation, Fenton reaction and photocatalysis, and photodynamic effect.

Subjects affected with inherited disorders, of the connective tissue make up an important population, carrying high risks as to distinct aspects of oral health and dental treatment. These generalized conditions may produce serious clinical symptoms in different orofacial structures, which have to be dealt with, or anticipated, when considering dental treatment. The most prevalent disorders result from deficiency of Type I collagen, an important extracellular matrix protein regulating both the structural and mechanical properties of most of the orofacial tissues. Recurrent jaw fractures, an increased liability for development of temporomandibular disorders, periodontal disease and mucosal fragility, an abnormal tooth color and/or shape, and pulp obliteration may feature as major clinical manifestations of the respective disorders. Deficiency of fibrillin, a protein providing soft tissues with elastic capacities, may produce a long face with a high and narrow palate, an increased liability for the developnet of temporomandibular disorders and periodontal disease, and root dsyplasia. Whenever present, these manifestations/risk factors have to be integrated in dental treatment strategies. In cases with high risk for cardiovascular complications, specific preventive measures, such as cardiac output monitoring and the administration of appropriate local anesthetics, have to be taken before starting any invase dental treatment. The present paper aims to provide the practitioner with an appreciation of the most prevalent inherited disorders of the connective tissue with their respective genetics, molecular aspects of pathology, medical and oral manifestations, and guidelines for dental treatment.