Figure 1 - uploaded by Jean-Charles Doucet
Content may be subject to copyright.
(A) Preoperative frontal view showing sclerotic skin, masklike appearance, and thin, atrophied, and incompetent lips. (B) Preoperative profile view illustrating the significant mandibular retrusion.
Source publication
Systemic sclerosis (SSc) is a multisystem connective tissue disease of unknown etiology. The hallmark of SSc is scleroderma, referring to the presence of thickened, hardened skin. Oral and maxillofacial manifestations of the disease are numerous including masklike appearance, trismus, muscular atrophy, thin atrophied lips, secondary microstomia, xe...
Contexts in source publication
Context 1
... scleroderma mainly affected her hands and the soft tissues of her face. Her lips were thin, atrophied, and incompetent. Significant mandibular retrusion was evi- dent. Vertical maxillary excess was present, and her chin was deficient (Fig. 1). Examination of her occlusion revealed a severe class II mandibular deficiency maloc- clusion with a large AOB (Fig. 2). Her AOB was 10 mm and her overjet was 7 mm. Occlusal contact was limited to her first and second molars bilaterally. Mouth opening was reduced with an interincisal opening of 37 mm (27 mm of movement from an AOB of ...
Context 2
... the patient was very pleased with the change in appearance (Fig. 8). Her occlusion was stable with 1 mm of overbite ( Fig. 9). Her interincisal opening was limited at 13 mm, and her lips were still incompetent. Lip exercises and jaw-opening exercises were prescribed. At 7 months, her occlusion was still stable and her opening was up to 26 mm (Fig. ...
Citations
... The implants come in three sizes: large, medium, and small. 28 An alveolar template (Radel® plastic) is used to select the appropriate alveolar implant size. The length of the implant is measured in millimeter increments. ...
Total temporomandibular joint replacement represents a significant advancement in oral and maxillofacial surgery by addressing the complex issues of temporomandibular joint dysfunction and degeneration. This procedure entails the implantation of a joint customized to the patient’s specific requirements, addressing conditions such as benign and malignant lesions, osteoarthritis, and more severe disorders. Available options range from standard commercial prosthetics to custom designs that leverage high-quality graphics and 3D printing for enhanced fit and functionality. Recent innovations have notably advanced temporomandibular joint surgery, with improvements in integration through information matching and shared processes that boost efficiency and longevity. Additionally, the adoption of minimally invasive techniques and robotic assistance has contributed to shorter recovery times, reduced complications, and increased surgical precision. However, challenges persist. Extended implant times, complications, and the need for ongoing patient care remain significant concerns. Long-term follow-up is crucial for evaluating the effectiveness and durability of new prosthetic designs. The field of temporomandibular joint replacement is rapidly evolving, driven by ongoing research and technological advancements aimed at improving patient outcomes, alleviating pain, and enhancing overall health. This review underscores the need for continuous innovation to address the complexities of integration and to advance patient care in the face of evolving surgical demands.
... Matarese et al. (2016) [17] observed that the frequency of bone alterations was significantly correlated with the mean duration of the disease [17], in the present case report, the patient showed signs of condylar degeneration twelve years after the SS diagnosis. However, there is no explicit correlation between the incidence of mandibular resorption and the severity, progression, and duration of SS [18]. ...
Scleroderma, an autoimmune disease, directly affects the production of collagen in the connective tissue. In its systemic form, the disease causes oral manifestations such as: limited mouth opening, xerostomia, periodontal disease, thickening of the periodontal ligament and bone resorption of the mandible. This case report aims to draw attention to the difficulties encountered in providing dental care to patients with scleroderma and also to highlight the imaging findings, with emphasis on the temporomandibular joints, which are of interest to dentists about the disease. In the present case, the patient presented bilateral condylar erosion, in addition to disc displacement without reduction. Due to the systemic condition of the patient, it was decided to make an individualized occlusal splint. The limitation of mouth opening is a limiting factor for the manufacture of prostheses and plates, which is why partial prostheses are indicated and are easily removed by the patient. The decisions taken have a great impact on the health and quality of life of patients in these conditions, so there is a need for multidisciplinary involvement in order to arrive at the best treatment plan. After five years of using the stabilizing plate overnight, the patient reports greater comfort and muscle relaxation upon waking up. KEYWORDS Case Reports; Diagnostic imaging; Systemic scleroderma; Temporomandibular joint; Temporomandibular joint disorders.
... Bilateral damage of the mandibular angle is more common than unilateral [6,10] which is correlated with findings in our case. There are studies involving patients with symmetrical resorption of condyles and authors claim that these cases are more prone to have TMJ disorders and anterior open bite [6,7,11]. Regarding dental manifestations of PSS most of them are correlated with limited oral hygiene or reduced saliva production. ...
Progressive systemic sclerosis (PSS) is chronic autoimmune disease affecting a connective tissue. The symptoms of PSS in orofacial area are: restricted mouth opening, xerostomia, facial asymmetry and problems with oral hygiene. Radiographic images can show specific features like bone resorption, especially in mandibular region or periodontal ligament space widening. The aim of this study was to present the case of 56-year-old woman with characteristic scleroderma-related changes visible on panoramic radiograph. The patient diagnosed with severe systemic sclerosis was referred by dermatologist to general dentist. The woman experienced tightening of facial skin, xerostomia and reduced mouth opening which caused problems with daily oral hygiene and dental treatment. General dentist referred the patient to the Department of Dental and Maxillofacial Radiodiagnostics of Medical University of Lublin for the panoramic X-ray. One of the main findings was bilateral resorption of mandibular angles. Localization of the bone resorption in patients with scleroderma is related to attachements of masticatory muscles. Dentists and general doctors should be aware that some of the maxillofacial manifestations of systematic scleroderma can be visible on panoramic radiographs.
... 3 Oral manifestations of systemic sclerosis may include limited ability to open the mouth, xerostomia, periodontal disease, enlarged periodontal ligament, and bone resorption of the jaw. 4 Facial skin thins and tightens, resulting in a mask-like appearance. 5 In severe microstomy, the interincisal distance is less than 30 mm. 6 Microstomy is mainly caused by submucosal collagen deposits that contribute to fibrosis in perioral tissue. 7 Limited mouth opening makes access to the oral cavity difficult for any dental procedure. ...
Introduction
Limited cutaneous systemic sclerosis with special manifestations (calcinosis cutis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) is part of the group of connective tissue diseases, these rare autoimmune systemic pathologies cause thickening and hardening of tissues in different parts of the body and can lead to complex disorders. Oral manifestations of systemic sclerosis may include limited ability to open the mouth, xerostomia, periodontal disease, enlarged periodontal ligament, and bone resorption of the jaw.
Case Description
A 54-year-old Caucasian patient presented with oral pain, swallowing, phonation and chewing difficulties associated with dental instability, hygiene/handling difficulties and her main problem with microstomia, which prevented her from removing the skeletal prosthesis for 4 years, depriving her of social life. Gradual treatment with dental implants was diagnosed and planned to support a fixed total denture adapted to the ridge with self-cleaning characteristics. After implant insertion, panoramic radiographs with standardized parameters were taken to compare crestal bone levels at the time of prosthesis placement and with 10 years of follow-up.
Conclusion
The average crestal bone loss of the 12 implants after the 10 years of follow-up was 1.26 mm for the maxilla and 1.17 mm for the mandible. The survival of the 12 support implants of two total fixed prostheses in a clinical/radiographic follow-up of 10 years was 100%. After 10 years of follow-up, the 12 implants inserted had a bone loss similar to that of healthy patients and no pathologies were registered, recovering function, aesthetics, and self-esteem. This therapy must be implemented before the interincisal distance decreases to 30 mm to allow intraoral surgical/prosthetic access. Implant-supported total fixed rehabilitation is a viable, predictable, and recommended therapy in patients with limited cutaneous systemic sclerosis.
... [14][15][16] SSc is more frequent and severe in African-Americans. 3,17,18 Dental and facial manifestations include: trismus (reduced interincisal distance) 19 ; secondary microstomia (reduced interlabial commissure distance) 20-22 ; dental caries [23][24][25][26] ; mask-like appearance; muscular atrophy; thin lips; xerostomia 19,25,27 ; rigidity with or without color change 28 of tongue and lips; periodontal ligament widening [29][30][31][32][33][34] ; periodontal attachment loss 26,35 ; trigeminal neuralgia [36][37][38] ; telangiectasia 19,39 ; oral mucosal/gingival fibrosis 2,40 ; gingival recession and stripping of attached gingiva 26,41 ; gastroesophageal reflux disease 42 ; temporomandibular disorders 43,44 and resorption of the angle of the mandible [45][46][47][48] ; as well as the coronoid process and the condyle. [49][50][51] The resorption has, on occasion, been so severe as to cause pathologic fracture of the mandible. ...
... 80%-90% DuBrul et al, 20 Bajraktari et al, 21 Baron et al 22 Mask-like cutaneous appearance 80%-90% Said et al, 19 Jung et al 26 Dental caries 3× Controls a Wood et al, 23 Baron et al, 22 Albilia et al, 42 Dagenais et al 50 Temporomandibular disorders 80%+ Ferreira et al, 43 Crincoli et al 44 Telangiectasia 70% Nagy et al, 39 Said et al, 19 Bajraktari et al 21 Periodontal ligament widening 30%-66% Marmary et al, 29 Auluck et al, 30 Krogh et al, 31 Anbiaee et al, 32 Jung et al, 26 Said et al, 19 Rowell et al 34 Gingival recession and stripping 2× Controls a Eversole et al, 41 Jung et al 26 Periodontal attachment loss 2x Controls a Pischon et al, 35 Jung et al, 26 Siefert et al, 33 Xerostomia 25%-71.2% Said et al, 19 Jung et al, 26 Nagy et al, 39 Chu et al, 25 Vincent et al, 27 Bajraktari et al 21 Mandibular resorption 8.6%-50% Auluck et al, 30 Rubin et al, 45 Doucet et al, 46 Pogrel et al, 49 Dagenais et al, 50 Jagger et al, 51 Mugino et al, 52 Siefert et al, 33 Haers et al 48 Trigeminal neuralgia 3%-17% Mohyuddin et al, 36 Farrel et al, 37 Jung et al, 26 Amaral et al, 38 Vincent et al, 27 Bajraktari et al 21 a Scleroderma patients' incidence was two or three times control group incidence. ...
To provide evidence supporting the off label use of pentoxifylline and vitamin E especially by dentists with TheraByte to reduce trismus in scleroderma patients. To provide evidence supporting the off label use of pentoxifylline and vitamin E especially by dentists with TheraByte to reduce trismus in scleroderma patients.
... It causes progressive fibrosis of the skin and sometimes also of internal organs because of an increased deposition of collagen (1)(2)(3). Although rgw pathogenesis of the disease is not known, it is thought that vascular abnormalities that might be caused by genetic, immunological and environmental factors have an important role in the pathogenesis (1,2,4). There are two types as limited cutaneous SSc and diffuse cutaneous SSc according to the women than in men (1,4,8). ...
... Although rgw pathogenesis of the disease is not known, it is thought that vascular abnormalities that might be caused by genetic, immunological and environmental factors have an important role in the pathogenesis (1,2,4). There are two types as limited cutaneous SSc and diffuse cutaneous SSc according to the women than in men (1,4,8). However, the patient presented in our case was a male and 46 years old. ...
... These patients have mask-like facies as a result of hardening and tightening of the skin inducing changes in the face, and reduced mouth opening (2,5,9). In our present study, the patient showed reduced mouth opening and had a extent of skin fibrosis and the pattern of organ system involvement (1,2,4,5). SSc is more frequent in women than men and the peak onset is between 30 and 65 years (2,4,5). ...
... Radiographically, the peri-apical space appears to be widened, while the ramus, coronoid process and mandibular condyle also display signs of bone resorption. Secondary Sjögren's syndrome is observed in 20% of the patients with systemic sclerosis (Doucet andMorrison, 2011, Laskaris, 2012). The main problems in the oral cavity and oral mucosa are ulcers, side effects from the therapeutic regime that is used, as well as dysphagia and inability to close the lips (which results in oral breathing and masticatory difficulties), peri-oral striations and limited mouth-opening capacity (Αlantar et al. 2011). ...
SUMMARY: Introduction: The use of dental implants represents a widely accepted and adequately documented
approach for the rehabilitation of edentulous patients.The need of both patients and clinicians for the reduction
of total treatment time led to the evolution of alternative techniques, such as immediate implant placement (IIP) in fresh extraction sockets. Materials and methods: After an electronic search in PubMed, published articles up to May 2017, written in English language, were selected for evaluation according to the aforementioned aims.
Results-Discussion: The IIP is a demanding surgical procedure with high survival rates similar to those of conservative implant placement protocol. Compared to the delayed placement, this technique does not seem to be more advantageous in terms of preservation of peri-implant bone and soft tissues.
Conclusions: The clinical applications of immediate implants have yielded immediate and predictable outcomes over long term follow-up periods. However, the treatment plan of IIP should be performed in selected
cases and adjustment of all special critical factors.
... Patients with SSc may present a Raynaud phenomenon, pulmonary hypertension, skin thickening, esophagealdysmotility, arthralgia, and renal insufficiency [1]. SSc causes several oral and maxillofacial manifestations such as masklike appearance, limited mouth opening, skin and muscular atrophy, peribuccalrhagades, thin atrophied lips, microstomia, xerostomia, widening of the periodontal ligament space, trigeminal neuralgia, telangiectasia and bone resorption of the mandible [2][3][4][5]. Few studies in the literature are published concerning the temporomandibular joint (TMJ) and masticatory muscles involvement in SSc. ...
... Few studies in the literature are published concerning the temporomandibular joint (TMJ) and masticatory muscles involvement in SSc. Most descriptions are based on individual cases or small numbers of patients with inadequate controls and do not define the relationship of oral manifestations to other manifestations of the disease [4,[6][7][8][9]. Thus, the frequency of TMJ and muscle disorders involvement in patients with SSc was poorly assessed. ...
... In this case, we report an internal derangement of TMJ, disk deformations revealed in a patient with SSc. We also reported bilateral resorption of the mandibular condylar process which is uncommon but it has been reported previously in patients with SSc [4,[6][7][8][9]. In the study of Haers and Sailer [6], the mandibular areas bone resorption affected by SSc are mandibular angle that was most involved, followed by the condyle, the coronoid process and finally the posterior border of the ascending ramus. ...
Systemic sclerosis have several effects on the orofacial region such as widening of the periodontal ligament space, xerostomia and bone resorption of the mandible. We report a case of systemic sclerosis with temporomandibular joint involvement in a 45-year-old female patient accompanied by severe limited mouth opening and pain in the right and left preauricular regions and tenderness in masseter muscles with a morning stiffness of jaws.Magnetic resonance imaging showed a resorption of mandibular condylar process, with disk and joint abnormalities.
... 53 Resorption is usually managed conservatively, but total TMJ reconstruction has been used in the management of significant condylar resorption. 12,54,55 ...
Systemic sclerosis (SSc) is a multisystem disease of unknown aetiology characterised by microangiopathy, dysregulated immune function and tissue remodelling, which commonly involves the oral cavity. Orofacial manifestations of SSc contribute greatly to overall disease burden and yet are regularly overlooked and under-treated. This may reflect a pre-occupation amongst rheumatology clinicians on potentially life-threatening internal organ involvement, but is also a consequence of insufficient engagement between rheumatologists and dental professionals. A high proportion of SSc patients report difficulty accessing a dentist with knowledge of the disease and there is recognition amongst dentists that this could impact negatively on patient care. This review shall describe the clinical features and burden of orofacial manifestations of SSc and the management of such problems. The case is made for greater collaborative working between rheumatologists and dental professionals with an interest in SSc in both the research and clinical setting.
... [1][2][3][4][5] These mainly include mask-like facial appearance, microstomia, periodontal diseases, widened periodontal ligament (PDL) space, xerostomia, and osseous resorption. [3][4][5][6][7][8] The present article reviews the orofacial considerations in scleroderma. ...
... [1] Although mainly thought of autoimmune origin, the other etiological factors such as genetic, environmental, nervous, and vascular are postulated to be the causes of the disease. [1,8,11] ...
... The blacks or African-Asians are involved more than whites or Caucasians. [1,2,8,13,16] The disorder primarily affects the females in the age group of 30-50 years. [16,17] Although disease manifests variably, the tightening of skin and Raynaud's phenomenon would be the early manifestation. ...
Scleroderma (skleros; hard, and derma; skin), is currently known as systemic sclerosis due to its progressive nature and widespread tissue involvement. It is a rare connective tissue disorder with a wide range of oral manifestations. Thickening of the skin is the hallmark of the disease. The patient education for self-care and multidisciplinary approach would be needed to manage the condition. The article presents the review of orofacial considerations in scleroderma with a report of analysis of orofacial manifestations 3 cases.
