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It is fashionable in professional circles to deplore the difficulty of intellectual discourse between "academicians" - men of letters, researchers, rationalist- and "practitioners" - surgeons, radiologists, physical therapists. How benefi cial it would be if educated non-academicians could speak intelligently about t-tests and chi-square tests and men of academia could appreciate the travail, spirit, and needs of a busy office and practice! Even this suspected gap between "two cultures" came very near together in the wonderful town of Groningen (The Netherlands) as wise men from both practice and scholarship gathered to talk about the unfathomables of the temporomandibular joint. There were keen discussions about the intense bio logical changes which occur about the complex temporomandibular joint after excessive use or injury. These papers were followed by talks outlining the experiences of those involved in the imaging and non-surgical and surgical management of patients who were enduring such changes. The pitch and interchange of opinions and evidence as to why a disc or its position could effect little or profound disturbance of the temporomandibular apparatus were en lightening to each who listened - and thought. And even more sobering was to hear the report of a well-documented, multiple decades long study of a large number of patients with osteoarthrosis and internal derangement which defined a natural course and eventual end of the disease. With this understanding, one is now faced with the obvious question of how much treatment patients with osteoarthrosis really require.

Management of Temporomandibular Joint Degenerative Diseases: Biologic Basis and Treatment Outcome

Temporomandibular joint degenerative diseases: pathogenesis.- Temporomandibular joint degenerative diseases: clinical diagnosis.- Temporomandibular joint disc displacement: a re-evaluation of its significance.- Treatment planning.- Rationale for non-surgical temporomandibular joint management.- Rationale for surgical temporomandibular joint management.- Orthognathic considerations in temporomandibular joint treatment planning.- Criteria for temporomandibular joint treatment outcome.- The current role of conventional radiography and computerized tomography in temporomandibular joint treatment planning.- The current role of magnetic resonance imaging in temporomandibular joint treatment planning.- Current role of diagnostic arthroscopy in temporomandibular joint treatment planning.- Surgical procedures: biologic basis and treatment outcome.- Temporomandibular joint arthrocentesis: biologic basis and treatment outcome.- Biologic basis and outcome of arthroscopic lysis and lavage of the temporomandibular joint.- Biologic basis for modified condylotomy in the management of temporomandibular joint degenerative diseases.- Temporomandibular joint disc surgery: biologic basis and treatment outcome.- Post-operative care and treatment failure.- Rehabilitation of the temporomandibular joint through the application of motion.- Post-operative physical therapy of the temporomandibular joint.- Correction of temporomandibular joint ankylosis resulting from earlier surgery.- Management of non-successful treatment outcome.- Synthesis.- Discussion of controversial statements.