FSTMK Annual Meeting 2011 - Foreningen af Specialtandlæger i ...

Final announcement
The Danish Association of Oral & Maxillofacial Surgeons
(Foreningen af Specialtandlæger i Tand- Mund- og Kæbekirurgi)
Annual Meeting Friday 4.11 – 5.11 2011, EC-hours = 9
Hindsgavl Castle, Middelfart, Fuen, Denmark
TMJ BOOT CAMP.
Speaker: David J. Psutka DDS, FRCD(C)
Dr. David Psutka has practiced as a specialist in Oral and Maxillofacial Surgery
in Toronto, Canada for 29 years. He is senior staff surgeon at the Mount Sinai
Hospital Center for Excellence in TMJ Reconstructive Surgery ( a national referral
center for TMJ replacement surgery. 760 alloplastic TMJ replacements have been
performed here since 1995). He is also attending surgeon at Credit Valley Hospital and
Trillium Hospital.
He teaches implant, TMJ and orthognathic surgery in the University of Toronto,
postgraduate training program in Oral and Maxillofacial Surgery. He has over 86
lectures and publications and has presented and demonstrated surgical
procedures across Canada, the US and Europe. Dr. Psutka is an examiner for the
Royal College of Dentists of Canada. He has been president of local and provincial
professional associations in Ontario, Canada and continues to represent oral and maxillofacial surgeons in
negotiations and health care planning with the Ontario Ministry of Health.
Summary:
The 21st century dentist and dental specialist, by virtue of their unique training and expertise are the most
appropriate health care provider to diagnose and manage patients with Temporomandibular Disorders. TMD’s
[1]

are ubiquitous, affecting 5 % of the population and causing millions of dollars in lost productivity and health care
expense. Every dental practitioner will encounter these patients frequently. Many TMD's are managed
successfully non-surgically. TMJ surgery has a definite role to play in TMD treatment algorithms and is currently
a very underutilized modality. This lecture will blend current dentofacial orthopedic and rheumatological concepts
necessary to a modern approach to understanding, diagnosing and treating TMD. In this presentation, Dr. David
J. Psutka will talk about:
Anatomy , growth and development
Physiology and Patho-physiology
Classification and Diagnosis of TMDs
An approach to management of TMDs.
A detailed overview of the current practice of TMJ Surgery.
Program:
Friday Nov. 04., 2011
8.00- 8.30 Register
8.30- 9.00 Breakfast
9.00- 9.10 Welcome – Troels B. Folkmar
9.10-11.00 Lecture: From embryology to total joint reconstruction
11.00-11.45 Coffee break and exhibition
11.45-12.30 Lecture: cont
12.30-13.30 Lunch
13.30-14.15 Lecture: cont
14.15-14.45 Coffee break and exhibition
14.45-15.50 Lecture: cont
15.50-16.20 Discussion
16.20-17.30 Topic related oral abstracts ( 10 min presentations)
• Thomas Klit Pedersen – Aarhus University Hospital
• Janek Dalsgaard Jensen – Aalborg Hospital
• Kristian Andersen – Aarhus University Hospital
• Lena Nørgaard – Odense University Hospital
• Nils Worsae - Rigshospitalet
• Esben Aagaard – Odense University Hospital
• Esben Aagaard – Odense University Hospital
19.00 Wellcome drink
19.30 Dinner
[2]

Saturday Nov. 5 2011
9.00-10.30 Residents hour – presentations mainly in Danish
• Jens Hartlev – Aarhus University Hospital
• Anja Carlsen – Aalborg Hospital
• Kristian Thesbjerg – Aalborg Hospital
• Tue Lindbjerg Blæhr – Aalborg Hospital
• Lone Fuks - Rigshospitalet
• Kristian Rude – Odense Universitetshospital
• Anders Torp Jensen - Rigshospitalet
• Pouya Yazdi - Rigshospitalet
10.45-12.30 General Assembley (only for members)
12.30 Lunch
13.30 End of Annual Meeting
[3]

Abstracts:
Friday Nov. 04., 2011
16.20-17.30 Topic related oral abstracts ( 10 min presentations)
Thomas Klit Pedersen, chief orthodontist, PhD
Department of Maxillofacial Surgery, Aarhus University Hospital, Department of Orthodontics,
Aarhus University, Denmark
Abstract
Inflammatory conditions of the temporomandibular joint.
Idiopathic condylar resorption, condylysis, progressive condylar osteolysis, condylar atrophy are all
terms used when a condition of changed morphology is seen of the mandibular condylar process. The
terminology does not give any explanation concerning the etiology and the processes leading to
condylar deformation. Furthermore, the course of progression and, maybe most important, the state of
stability of the joint are not documented to a sufficient level assuring a constant result of the
reconstructive treatment necessary to retrieve adequate, asymptomatic function and esthetics.
Pathologic changes of the components of the temporomandibular joint causes mandibular positional
alterations in adults and growth disturbances in the juvenile. Uncertainness exists concerning etiology,
diagnosis, prognostic assessment, treatment and defining stability of the joint. The present lecture
discusses possible etiology from an inflammatory point of view, possible treatment modalities and joint
stability. A method for determining the state of pathology in the joint are described in order to support
diagnosis and treatment.
Jannek Dalsgaard Jensen, Consultant Oral and Maxillofacial Surgeon
[4]

Dept. of Maxillofacial Surgery, Aalborg Hospital, Denmark
Abstract:
Modified condylotomi
The modified condylotomi is an ekstra-articular surgical procedure used to manage patients with
temporomandibular joint dysfunction. I will go through the procedure and tell you about the patients we
have been treated in Aalborg.
Kristian Andersen - PhD student
Department of Maxillofacial Surgery, Aarhus University Hospital, Denmark
Abstract
Long-term follow-up on total reconstruction of the temporomandibular joint - functional,
psychosocial and radiological assessments in a case-series study.
Andersen K, Dahl M, Nørholt SE, Futarmal S, Svensson P.
Department of Oral and Maxillofacial Surgery, Aarhus University Hospital and Department of
Clinical Oral Physiology, Institute of Odontology, Aarhus University.
This case-series included seven subjects who had total joint reconstruction with Biomet® Total
Temporomandibular Joint (TMJ) Replacement System at Department of Oral and Maxillofacial
Surgery, Aarhus University Hospital. The follow-up examination included a functional, psychosocial
and radiological examination. The functional assessment was conducted according to the Research
Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The radiological assessment
involved a cone beam computed tomography (CBCT) (NewTom, USA). Oral health impact on quality
of life was assessed by the Danish version of the Oral Health Impact Profile questionnaire (OHIP).
Results: The prostheses were placed in average six years before the follow-up examination (range 4-9
years). The range of mandibular movement was low in all directions. According to the RDC-TMD
algorithm four subjects had myofacial pain. Two patients had a high chronic pain disability and three
patients had a low disability. Patients with TMD disability had a high impact of oral health on quality of
life for the sub-domains functional limitation, physical pain and physical disability. Heterotopic bone
formation on the medial aspect of the reconstruction was observed in 8 out of 12 TMJ-reconstructions.
Conclusion: This case-series study showed a 100 per cent survival rate of Biomet® Total
Temporomandibular Joint (TMJ) Replacement System after six years of observation. A high occurrence
of heterotopic bone formation on the medial aspect of the prostheses was observed. Furthermore, some
patients had a chronic pain disability, low range of mandibular movement and impact of oral health on
quality of life. Further studies are needed.
[5]

Lena Nørgaard,
Dept. of Maxillofacial Surgery, Odense University Hospital, Denmark
Abstract
Synovial chondromatosis in the temporomandibular joint
Introduction: Synovial chondromatosis in the temporomandibular joint is a rare, benigne condition.
The clinical findings include formation of metaplastic cartilage in the synovium of the joint.
Subsequently, This hyperplastic formation results in numerous attached osteocartilagenous bodies.
Furthermore, cartilagenous bodies are seen in the synovium. The etiology is unknown and diagnosis is
often delayed due to the non specific symptoms.
Materials and methods: We present a case of a 28 year old woman. The patient presented with a
history of persisting, temporomandibular joint pain and crepitus in both joints and a self reported
sensation of dual bite. Previous treatments included arthroscopy in the left joint, without specific
findings and no effect on the patients symptoms. Furthermore, we present a review of the literature
based on a systematic search in the National Library of Medicine´s PubMed. Search criteria included
Synovial chondromatosis, temporomandibular joint .
RESULTS: Following a new bilateral arthroscopy, the patient presents without symptoms and clinical
and histologic findings revealed the diagnosis Synovial chondromatosis. 31 articles from 1952 to 2011
confirmed, that this disease is a rare benigne condition with low recurrence. No authors have described
transformation into malignant disease in the temporomandibular joint.
CONCLUSION:Proper treatment and histologic verification of the clinical findings in cases with
synovial chondromatosis are pertinent. The literature suggests removal of cartilage bodies or synovium
and cartilage bodies, with open joint surgery or arthroscopy
Nils Worsaae, DDS, Consultant Oral and Maxillofacial Surgeon
Dept. of Maxillofacial Surgery, Rigshospitalet, University of Copenhagen, Denmark
Abstract
[6]

Interpositional arthroplasty of patients with TMJ-arthrosis. Short term results.
A prospective study of 25 patients surgically treated forTMJ-arthrosis with interpositional arthroplasty
using homologeous costal cartilage grafts (Tutoplast®) from 2007-2010.
Results: Interincisal opening increased from median 31 mm (17-42) to 40 mm (37-44) and VAS pain
score (0-10) was reduced from median 8 (6-9) to 2 (0-5.5) during the first year of follow-up.
Complication with fragmentation of the interpositional material happened in one patient who was later
reoperated. No other complications occurred
From 2010 to 2011 ten additional patients have been operated with similar good results, except for two
problematic cases.
Conclusions: If the results of this moderate surgical approach are more long-standing it may be an
alternative to more aggressive surgery in patients with severe TMJ arthrosis, although there are some
limitations.
Esben Aagaard, Consultant Oral and Maxillofacial Surgeon
Dept. of Maxillofacial Surgery, Odense University Hospital, Denmark
Abstract 1
Combining Alloplastic TMJ Reconstruction with Orthognathic Movements via Digital
Preoperative Planning and Custom Prostheses
Aagaard E.*, Thygesen T.H.*, Flannery N.M.P.**, Weimer K.A.**, Christensen A.M.**
*Dept. of Oral & Maxillofacial Surgery, Odense University Hospital, Denmark
**Medical Modeling Inc., Golden, Colorado USA
Purpose: Virtual surgical planning with CAD/CAM templates have been shown to facilitate
orthognathic surgery as a viable alternative to traditional planning methods. Alloplastic reconstruction
of the temporomandibular joint (TMJ) is performed with either off-the-shelf or custom components
designed using traditional, non-digital methods. Over the last few years digital design of custom TMJ
prostheses (Biomet MicroFixation) has proven to be accurate and effective. Concomitant reconstruction
of the TMJ with orthognathic movements can now be directed from a completely digital plan involving
CAD/CAM joint prostheses and CAD/CAM intermediate and/or final occlusal splints.
Methods & Materials: Preoperative CT scans (0.75mm - 1.25mm slice spacing, .3mm-.45mm pixel
size) were taken of patients requiring both orthognathic surgery and alloplastic replacement of the TMJ.
The medical images were imported into the virtual surgical planning software and three-dimensional
virtual models were created. The orthognathic surgery was digitally planned in a meeting between the
surgeon and an engineer at the modeling company. Simulated post-operative digital models were then
utilized to design customized total TMJ prostheses in a completely digital fashion. Custom implant
components, anatomical model(s), surgical guide(s), orthognathic splint(s) and other template(s) were
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then designed and fabricated from the finalized virtual surgical plan and sent to the surgeon for use in
the surgery.
Results: Post operative evaluations of the surgical procedure, how the custom instruments facilitated
the procedure, and how well the total joint prostheses fit will be discussed for a series of patients who
underwent this procedure.
Conclusion: A completely digital plan can be put together to simulate orthognathic movements and
total TMJ replacement with its outputs being produced by CAD/CAM technology. Precision of implants
and movements is predicatable and should be considered for cases needing combined TMJ replacement
and orthognathic procedures.
Abstract 2
A prospective, Single Center Study on Patient Outcomes Following Temporomandibular Joint
Replacement Using a Custom Made Biomet TMJ Prosthesis.
1. Esben Aagaard, DDS, Chief Surgeon, 2. Torben H. Thygesen, DDS, PhD, Chief Surgeon,
Department of Oral and Maxillofacial Surgery, Odense University Hospital, Soender Boulevard 29,
5000 Odense C, Denmark, Europe
Introduction: Traditionally, the treatment of temporomandibular disorders were based on diagnostic
assessments, patient information, splint therapy, arthroscopies, arthrocentesis and finally, open joint
surgeries. Earlier results of alloplastic TMJ surgery revealed inconsistent outcomes. In recent years,
promising results with total joint reconstruction using new prosthesis types are published.
Aim: This prospective, consecutive cohort clinical study aimed to describe a wide range of pre- and
postoperative clinical variables following uni- or bilateral total, alloplastic TMJ reconstruction using a
patient matched implant (TAR). (Biomet Microfixation´s Patient Matched Temporomandibular Joint
(TMJ) Implant).
Material and methods: A total of 81 alloplastic TMJ reconstructions were performed in 63 consecutive
patients between November 2007 and August 2010. Five men and fifty-eight females (41 ± 16 years),
participated in up to nine sessions: one before alloplastic reconstruction and 1 week, 1, 3, 6 12, 18, 24
and 36 months after alloplastic TMJ reconstruction in either one or both sides (47 unilateral and 17
bilateral). All patients were classified by the Wilkes Classification (n=5 Class III; n=19 Class IV; n=47
Class V). Ten patients could not be staged by Wilkes classification (fracture, ankylosis, revisions and
benign neoplasms). At each session VAS scores on jaw pain intensity were scored, as well as clinical
evaluation of maximum incisal opening (MIO). In addition, frequency of adverse events such as
hematoma, infection, swelling trismus, and joint revision were recorded.
Results: The most common diagnoses were degenerated/resorbed joints (85.2%) and osteoarthritis
(79.0%). The most common previous surgical treatment was arthroscopic lavage (81.5%). The mean
follow up was 14.1 months (range: 3 months - 3 years). The results showed significant improvement
relative to baseline (p

pain and unspecific swelling and one implant was removed due to severe infection and pain. The
remaining adverse events resolved through proper treatment with antibiotics.
Conclusions: The present study indicates, that TAR is a relevant treatment option, even in patients with
a broad range of temporomandibular disorders. Our results showed, that the mean patients gained
almost normal range of mouth opening and gained a significant reduction of pain following surgery.
Although our results seem promising, it should be emphasized, that TAR is associated with some side
effects and, thus, should only be used when less invasive procedures fail and a comprehensive
presurgical work up is performed. Ongoing prospective studies with longer term follow-up are needed
to consolidate possible significant treatment outcomes.
[9]

Saturday Nov. 5 2011
9.00-10.00 Residents hour
Jens Hartlev, resident
Department of Maxillofacial Surgery, Aarhus University Hospital, NBG, Denmark
Abstract
Delvis rekonstruktion af zygomamaksil-komplekset med computer- designet alloplastisk
implantat
Baggrund: Kraniedefekter kan rekonstrueres med computerdesignede alloplastiske implantater.
Polyetheretherketones (PEEK) patient specifikt implantat (PSI) til rekonstruktion af atrofi af zygomamaksilregionen
er et nyt behandlingsalternativ, der ikke tidligere er beskrevet i litteraturen.
Patienttilfælde 1: En 18-årig mand henvises fra Øjenafdelingen, Aarhus Sygehus til Tand-, Mund- og
Kæbekirurgisk Afdeling med henblik på rekonstruktion af atrofi omkring højre zygoma-maksilregion
efter stråleterapi i tidlig barndom pga. retinoblastom. Ved en mindre kirurgisk operation korrigeres det
atrofiske område vha. et PEEK PSI.
Patienttilfælde 2: En 30-årig mand henvises fra Skadestuen, Aarhus Sygehus til Tand-, Mund- og
Kæbekirurgisk Afdeling, med henblik på sekundær korrektion af ansigtsasymmetri omkring venstre
zygoma-maksilregion efter traume. Ved en mindre kirurgisk operation korrigeres det asymmetriske
område vha. et PEEK PSI.
Konklusion: Rekonstruktion af ansigtsdeformiteter med et computerdesignet PEEK-PSI må i disse
patienttilfælde betegnes som en succesfuld behandling i både funktionel, kosmetisk og psykologisk
henseende. Operationen er af mindre invasiv karakter med få postoperative gener.
Anja Carlsen, resident
Dept. of Maxillofacial Surgery, Aalborg Hospital, Denmark
Abstract
Donor site complications when harvesting from the mandible ramus
[10]

Background: Treatment of tooth loss with osseointegrated oral implants has a high success rate.
However, placement of implants is frequently comprised or impossible due to atrophy of the alveolar
process. Autogenous bone is generally the preferred graft material for reconstruction of the alveolar
process and is usually harvested from the mandibular ramus. However the use of autogenous bone
grafts is associated with the risk of donor site morbidity and complications.
Purpose: The aim of the present study was to evaluate the morbidity and complications after bone
harvesting from the mandibular ramus.
Material and methods: 374 surgical procedures performed at The Department of Oral and Maxillofacial
Surgery in Aalborg from the year 2000 to 2010 were retrospectively analysed based on records and Xrays.
Data from records and X-rays was conducted according to registration sheet.
Results: The frequency of temporary change in sensitivity was 5,9 % (n=22). The frequency of
permanent reduced sensitivity was 0,5% (n=2). Hematoma occurred in 20 cases. Infection was
registered in one case.
Conclusion: The results of this study showed that bone harvested from the mandibular ramus is a safe
surgical procedure with few complications.
Kristian Thesbjerg, resident
Dept. of Maxillofacial Surgery, Aalborg Hospital, Denmark
Abstract
Deviation af næseseptum ved SARME
Formål: At undersøge om løsning af næseseptum i forbindelse med SARME operationer har betydning
for postoperativ deviation af næseseptum.
Materiale og metode: I alt 20 patienter indgik i undersøgelsen (M=9, F=11) Patienterne blev vilkårligt
grupperet i to grupper. Gruppe I (n=10) med løsning af næseseptum og gruppe II (n=10) uden løsning af
næseseptum. På alle patienterne blev der foretaget CBCT optagelser umiddelbart før
distraktionsprocessen og ved afsluttet distraktion. Opmåling blev foretaget i Dolphin Imaging 11.0.
Målemetoden blev testet ved at opmåle samme 10 patienter 2 gange med en uges mellemrum.
Resultater: Gruppe I: 4 patienter viste en deviation på > 1,5 mm. efter distraktion. Gruppe II 1 patient
havde deviation på > 1,5mm. Metode studie viste en maximalt SD på 0,46 mm og et konfidensniveau
95 % på maximalt 0,33 mm.
Diskussion/konklusion: Nærværende undersøgelse viser at løsning af næseseptum er nødvendig i
forbindelse med SARME. Imidlertid er den kliniske betydning for den øgede risiko for deviation af
næseseptum stadig uklar, men formentlig uden betydning. Der er med baggrund heri grundlag for
yderligere undersøgelse, involverende en klinisk vurdering af næseseptum
[11]

Lone Fuks, resident
Dept. of Oral and Maxillofacial Surgery, Rigshospitalet, University of Copenhagen, Denmark
Abstract
SAPHO syndrom.
Præsentation af et klinisk tilfælde, gennemgang af symptomer og behandlingmuligheder.
Dette syndrom bliver ofte overset ved udredning af patienter med klinisk manifesteret osteomyelitis og
fejldiagnostiseres derfor med diagnosen "diffus scleroserende osteomyelitis" . Fejlagtig opstartes
langvarig antibiotika behandling uden den ønskede effekt.
Syndromet er bl.a. kendetegnet ved udvikling af "steril knoglenekrose" samt hud- og ledgener.
Tue Lindbjerg Blæhr, resident
Dept. of Maxillofacial Surgery, Aalborg Hospital, Denmark
Abstract
Benign fibrøs histiocytom, en case
Benign fibrøs histiocytom er en mesenkymal tumor, der oftest optræder i huden på ekstremiteterne. Den
ses meget sjældent i knoglevæv og ekstremt sjældent i kæbeskelettet. Tumoren forekommer i alle aldre,
men oftest over 60-års alderen. Tumoren præsenterer sig i knogle oftest som en som en langsomt
voksende hævelse medførende ekspansion af knoglen og eventuelt patologisk fraktur. Benign fibrøs
histiocytom kan vokse aggressivt med indvækst i nærliggende anatomiske regioner, og behandles med
kirurgisk resektion. I nærværende kasuistik præsenteres en 73-årig kvinde med et benign fibrøs
histiocytom i underkæben, og de differentialdiagnostiske overvejelser diskuteres.
Kristian Rude, resident
Dept. of Maxillofacial Surgery, Odense University Hospital, Denmark
Abstract
Recenstruction of the maxilla using the fibula graft, immidiat implant placement and virtual
planning techniques
[12]

Purpose
Presentation of a case of maxillary reconstruction using the microvascularized fibula graft, medpore
implant and immidiate dental implants. Preoperative CT scans, manufacturing of rapid prototyping
surgery template. Pre- and postoperative CT scans illustrating the predictability of the surgry.
Dental implants are placed using template before (transplant) of the fibula graft making the case unique.
Key words:
Fibula graft, maxillary reconstruction, virtual planning,dental implants
Case presentation
A 15 year-old female introduced to the department of plastic surgery and the department of oral and
maxillofacial surgery for (seeking) reconstruction of her right maxillary.
1) Diagnose venøs vaskulær
2) Primær kirurgi
3) Resektion
4) Præoperativ: æstetisk og funktionel problematik, herunder obturator, syn tygge,
tale,livskvalitet
5) ”Backward planning” mandibel positio – implantat position – postition af fibula
6) transplantat
Visuelt materiale:
Klinisk foto præ-OP ( en face, profil)
Pre- and postsurgical CT Superimposer
Virtual plan and postsurgical CT superimposed
Anders Torp Jensen, resident
Dept. of Oral and Maxillofacial Surgery, Rigshospitalet, University of Copenhagen, Denmark
Abstract
Diagnostik og behandling af fibrøs dysplasi
Der vil blive lagt vægt på differentialdiagnostikken med det ossificerende fibrom, herunder nye
muligheder for diffentialdiagnostik vha. molekylærbiologi.
Behandlingsmuligheder med Bisphosphonat-præperater, samt bedre forudsigelsen af fortsat progression
ved måling af alkalisk phosphatase.
Pouya Yazdi, resident
Dept. of Oral and Maxillofacial Surgery, Rigshospitalet, University of Copenhagen, Denmark
Abstract
Tromboseprofylakse i forbindelse med tand,- mund- og kæbekirurgiske indgreb.
[13]

Baggrund: Venøs tromboembolisme (VTE), defineret som dyb venøs trombose (DVT), lungeemboli
(LE), eller en kombination af begge, er blandt de mest hyppige komplikationer hos indlagte patienter.
LE er den hyppigste årsag til mortalitet blandt indlagte patienter, som kan forebygges. Med den
kontinuerlige udvidelse af både det kirurgiske felt, samt behandling af kompleks medicinske patienter
indenfor tand,- mund- og kæbekirurgi, er det en nødvendighed at have fokus på risikofaktorer for VTE.
Formål: At give et indblik i eksisterende litteratur på området, samt at omtale gældende retningslinjer
vedrørende tromboseprofylakse.
[14]