Preface Acknowledgments Table of Contents Introduction Primary Dental Evaluation Anatomy of the Masticatory System Manual Functional Analysis Imaging Procedures Mounting of Casts and Occlusal Analysis Instrumented Analysis of Jaw Movement Diagnoses and Classiflications Principles of Treatment Illustration Credits References Index

TMJ Disorders and Orofacial Pain: The Role of Dentistry in a Multidisciplinary Diagnostic Approach

Summary The morphology and function of the discomuscular apparatus of the human TMJ is a controversial subject. Connections between the muscles which move the mandible and the “disco-capsular complex” have been described in a contradictory way. The disco-muscular apparatus is also described as being more extensive than that of the M. pterygoideus alone to include to the Mm. temporalis and masseter. However, the involvement of the latter is considered to be a peripheral variation of the normal anatomy and of little, if any, functional significance. The existence of independent relationships between the deep portions of the masseter and temporal muscles and the disco-capsular apparatus of the human TMJ is rarely discussed or explained. The morphologic findings were derived from fixed and unfixed human temporomandibular joints (TMJ) of varying ages and both sexes, whereby the functional maturity of the masticatory apparatus was taken into consideration. The results of the study show that aside from fibers originating from the superior venter of the M. pterygoideus lateralis, additional muscle or connective tissue fibers from the perimysium of the M. masseter are inserted to varying extents into the disc. The same is true for the M. temporalis, which is also directly connected to the disc via muscular or fibrous elements, or indirectly via fibers from the M. masseter. The insertion of the M. pterygoideus lateralis is always in the medial portion of the Discus articularis and those of the Mm. temporalis and masseter in the middle and lateral portions of the disc respectively. It is highly probable that a direct force transfer through the Mm. temporalis and masseter to the articular disc takes place, and that these muscles contribute to the movement of the disc during jaw movement, whereas the size and form of the muscle insertions are subject to a great deal of individual variation.

The function of the disco-muscular apparatus in the human temporomandibular joint.

While clinical studies on acute phase proteins (APPs) have significantly increased in the last decade, and most commercial labs are now offering major APPs in their biochemical profiles, APP testing has not been widely adopted by veterinary clinical pathologists and veterinarians. Measurement of APP concentration is a useful marker for detecting the presence or absence of inflammation in cats with various diseases. APPs can also be reliably measured in different biological fluids (eg, effusions and urine) to improve their diagnostic utility. Measurement of APPs can be extremely beneficial in cats with feline infectious peritonitis (FIP) to discriminate between FIP and non-FIP cats with similar clinical presentations. Additional benefits come from multiple and sequential measurements of APPs, particularly in the assessment of therapeutic efficacy. APPs are more sensitive than WBC counts for early detection of inflammation and to demonstrate an early remission or recurrence of the diseases. Given the potential utility of APPs, more studies are warranted, with a particular focus on the applications of APPs to guide the length of antimicrobial therapies, as suggested by the antimicrobial stewardship policy. New inflammatory markers have been discovered in human medicine, with a higher specificity for distinguishing between septic versus nonseptic inflammatory diseases. It is desirable that these new markers be investigated in veterinary medicine, to further test the power of APPs in diagnostic setting.

Acute phase proteins in cats: Diagnostic and prognostic role, future directions, and analytical challenges.

Feline infectious peritonitis (FIP) remains a major diagnostic and treatment challenge in feline medicine. An ineffective immune response is an important component of FIP pathophysiology; hence treatment with an immune stimulant such as Polyprenyl Immunostimulant™ (PI), which enhances cell-mediated immunity by upregulating the innate immune response via Toll-like receptors, is a rational approach. Records of cats with FIP treated with PI orally for over 365 days were retrospectively studied. Of these cats (n = 174), records were obtained for n = 103 cats with appropriate clinical signs and clinical pathology. Of these, n = 29 had FIP confirmed by immunohistochemistry (IHC) or reverse transcription polymerase-chain-reaction (RT-PCR). Most of the cats (25/29; 86%) had non-effusive FIP, and only 4/29 cats (14%) had effusive FIP. The mean survival time (MST) was 2927 days (eight years); with 55% of the cats (16/29) still being alive at the time data collection, and 45% (13/29) having died. A persistently low hematocrit plus low albumin:globulin (A:G) ratio, despite treatment, was a negative prognostic indicator. It took a mean of ~182 days and ~375 days, respectively, for anemia and low A:G ratio to resolve in the cats that presented with these laboratory changes. This study shows that PI is beneficial in the treatment of FIP, and more studies are needed to establish the best protocols of use.

/pdf/retrospective-survival-analysis-of-cats-with-feline-iznpbxsy.pdf

Retrospective Survival Analysis of Cats with Feline Infectious Peritonitis Treated with Polyprenyl Immunostimulant That Survived over 365 Days

Simple Summary Feline infectious peritonitis is a fatal disease classified into the effusive form, the non-effusive form, or their mixture showing clinical signs of both forms. To determine whether the therapeutic effect of Mutian on the non-effusive and the mixed forms of feline infectious peritonitis can be predicted using clinical indicators before starting treatment, we entered 161 cats with the mixed form and 163 cats with the non-effusive form into this study. Physical assessment, detection of viral genes, and several clinical laboratory tests were performed before Mutian was administered. These indicators were compared between the disease groups that survived after receiving Mutian for 84 days and those that died before the completion of treatment. Significant differences in body temperature, appetite scores, and activity scores were confirmed between the surviving and non-surviving groups. The therapeutic effect was insufficient when total bilirubin levels increased in cats with the mixed form. In both forms of feline infectious peritonitis, therapeutic effects were difficult to obtain when neurological clinical signs had been observed. The therapeutic effects of Mutian on the cats with these forms of feline infectious peritonitis can be predicted based on pre-treatment body temperature, appetite scores, and activity scores, as well as the presence of neurological signs. Abstract Feline infectious peritonitis (FIP) is a fatal disease classified as either effusive, non-effusive (‘dry’), or a mixture (‘mixed’) of the forms of FIP, with mixed showing signs of both effusive and dry. To determine whether the therapeutic effect of Mutian on dry and mixed FIP can be predicted using clinical indicators before starting treatment, we entered 161 cats with mixed FIP and 163 cats with dry FIP into this study. Physical assessments, the reverse transcriptase-PCR detection of viral genes, and clinical laboratory tests (hematocrit, albumin/globulin ratio, serum amyloid A, α1-acid glycoprotein, and total bilirubin) were performed before Mutian was administered. These indicators were compared between the FIP groups that survived after receiving Mutian for 84 days and those that died before the completion of treatment. Significant differences in body temperature, appetite, and activity scores were confirmed between the surviving and non-surviving groups. The therapeutic effect was insufficient when total bilirubin levels increased in cats with the mixed form. In both of the FIP types, therapeutic effects were difficult to obtain when neurological clinical signs were observed. The therapeutic effects of Mutian on the cats with dry and mixed FIP can be predicted based on pre-treatment body temperature, appetite scores, and activity scores, as well as the presence of neurological signs.

/pdf/prognostic-prediction-for-therapeutic-effects-of-mutian-on-7a51i88e.pdf

Prognostic Prediction for Therapeutic Effects of Mutian on 324 Client-Owned Cats with Feline Infectious Peritonitis Based on Clinical Laboratory Indicators and Physical Signs

Feline infectious peritonitis (FIP) is a systemic immune-mediated inflammatory perivasculitis that occurs in a minority of cats infected with feline coronavirus (FCoV). Various therapies have been employed to treat this condition, which was previously usually fatal, though no parameters for differentiating FIP recovery from remission have been defined to enable clinicians to decide when it is safe to discontinue treatment. This retrospective observational study shows that a consistent reduction of the acute phase protein alpha-1 acid glycoprotein (AGP) to within normal limits (WNL, i.e., 500 μg/mL or below), as opposed to duration of survival, distinguishes recovery from remission. Forty-two cats were diagnosed with FIP: 75% (12/16) of effusive and 54% (14/26) of non-effusive FIP cases recovered. Presenting with the effusive or non-effusive form did not affect whether or not a cat fully recovered (p = 0.2). AGP consistently reduced to WNL in 26 recovered cats but remained elevated in 16 cats in remission, dipping to normal once in two of the latter. Anaemia was present in 77% (23/30) of the cats and resolved more quickly than AGP in six recovered cats. The presence of anaemia did not affect the cat’s chances of recovery (p = 0.1). Lymphopenia was observed in 43% (16/37) of the cats and reversed in nine recovered cats but did not reverse in seven lymphopenic cats in the remission group. Fewer recovered cats (9/24: 37%) than remission cats (7/13: 54%) were lymphopenic, but the difference was not statistically different (p = 0.5). Hyperglobulinaemia was slower than AGP to return to WNL in the recovered cats. FCoV antibody titre was high in all 42 cats at the outset. It decreased significantly in 7 recovered cats but too slowly to be a useful parameter to determine discontinuation of antiviral treatments. Conclusion: a sustained return to normal levels of AGP was the most rapid and consistent indicator for differentiating recovery from remission following treatment for FIP. This study provides a useful model for differentiating recovery from chronic coronavirus disease using acute phase protein monitoring.

/pdf/alpha-1-acid-glycoprotein-reduction-differentiated-recovery-1kzi54yj.pdf

Alpha-1 Acid Glycoprotein Reduction Differentiated Recovery from Remission in a Small Cohort of Cats Treated for Feline Infectious Peritonitis

The correlation between disc displacements in the temporomandibular joint and the petrotympanic, petrosquamous and tympanosquamous fissures was investigated in 38 corpses. Only 12 joints had no ossification of the fissures, while 26 joints were partially ossified. With one exception, none of the joints with non-ossified fissures revealed disc displacement. In contrast, all the joints with ossified fissures revealed disc displacement. Women proved to have more displaced discs than men. On the basis of the findings, a model of the etiology of disc displacement is discussed.

[The significance of the fissurae petrotympanica, petrosquamosa and tympanosquamosa for disk displacements in the temporomandibular joint].


 Feline infectious peritonitis (FIP) is a systemic immune-mediated inflammatory perivasculitis which occurs in a minority of cats infected with feline coronavirus (FCoV). A variety of therapies have been employed to treat this condition, which previously was usually fatal, but no parameters for differentiating FIP recovery from remission have been defined to enable clinicians to decide when it is safe to discontinue treatment. This observational study shows that a consistent reduction of the acute phase protein alpha-1 acid glycoprotein (AGP) to within normal limits (WNL i.e. 500μg/ml or below), as opposed to duration of survival, distinguishes recovery from remission. AGP consistently reduced to WNL in 26 recovered cats but remained elevated in 16 cats in remission, dipping to normal once in two of the latter. Anaemia was present in 58% (23/40) of the cats, and resolved more quickly than AGP in six recovered cats. Lymphopenia was observed in 43% (16/37) of the cats and reversed in nine recovered cats, but none of the remission group. Hyperglobulinaemia was slower than AGP to return to WNL in the recovered cats. FCoV antibody titre was high in all 42 cats at the outset and decreased significantly in 7 recovered cats, but too slowly to be a useful parameter to determine discontinuation of anti-viral treatments. Conclusion: a sustained return to normal levels of AGP was the most rapid and consistent indicator for differentiating recovery from remission following treatment for FIP. This study provides a useful model for differentiating acute from chronic coronavirus disease using acute phase protein monitoring.

/pdf/alpha-1-acid-glycoprotein-reduction-differentiates-recovery-3deukr6p.pdf

P. Brauckmann

Papers

Alpha-1 Acid Glycoprotein Reduction Differentiated Recovery from Remission in a Small Cohort of Cats Treated for Feline Infectious Peritonitis

[The significance of the fissurae petrotympanica, petrosquamosa and tympanosquamosa for disk displacements in the temporomandibular joint].

Alpha-1 acid glycoprotein reduction differentiates recovery from remission in feline infectious peritonitis treatment