Ultrastructural quantification of collagen in the articular disc of the temporomandibular joint of the rabbit

Evaluation of Stress on Acupuncture with Nano-Etched and Diamond-Like Carbon (DLC) Coating Surface Modifications

The aim of the present study was to investigate the effect of nano-etched surface and diamond-like carbon (DLC) surface acupuncture needles on human pain perception, by finite element method (FEM). Skin models were reconstructed by 3D computer programs. The stress is an important role in acupuncture needle applications for clinical treatment. Many studies have investigated finite element researches for acupuncture; however, few have evaluated a model for acupuncture with and without\ modified surface. The results revealed that abnormal focusing stress was found when acupuncture with nano-etched surface. Moreover, the unbalance stress was found on the top of the skin model in the nano-etched group, the highest stress also appeared in the top region. Acupuncture with nano-etched surface would be an effective means for stimulating skin. These results indicate subtle but significant effects of acupuncture stimulation with nano-etched surface needles, compared to acupuncture with untreated needles in healthy participants.

Fibrochondrocyte Growth and Functionality on TiO₂ Nanothin Films

Disorders affecting the temporomandibular joint (TMJ) are a long-standing health concern. TMJ disorders (TMJD) are often associated with an internal disc derangement accompanied by a suite of symptoms including joint noises, jaw dysfunction, and severe pain. The severity of patient symptoms and their reoccurrence can be alleviated to some extent with conservative therapy; however, refractory cases often require surgery that has shown only limited success. Bioengineered scaffolds with cell supportive surfaces an d nanoarchitectures that mimic TMJ tissue structure may offer an alternative treatment modality. In this study, titanium dioxide (TiO₂) nanothin films, fabricated by layer-by-layer assembly, were examined as means for creating such a scaffold. The viability and growth of TMJ discal fibrochondrocytes (FCs) were assessed through MTT and DNA assays and total protein content over a 14-day experimental period. ELISA was also used to measure expression of types I and II collagen, decorin and aggrecan. Quantitative analyses demonstrated that FCs synthesized characteristic discal matrix proteins, with an increased production of type I collagen and decorin as opposed to collagen type II and aggrecan. A stimulatory effect on discal FC proliferation and extracellular matrix (ECM) expression with thicker nanofilms was also observed. The cumulative results suggest that TiO₂ nanofilms may have potential as a TMJ scaffolding material.

The effects of oxygen level and glucose concentration on the metabolism of porcine TMJ disc cells

OBJECTIVE

To determine the combined effect of oxygen level and glucose concentration on cell viability, ATP production, and matrix synthesis of temporomandibular joint (TMJ) disc cells.

DESIGN

TMJ disc cells were isolated from pigs aged 6-8 months and cultured in a monolayer. Cell cultures were preconditioned for 48 h with 0, 1.5, 5, or 25 mM glucose DMEM under 1%, 5%, 10%, or 21% O2 level, respectively. The cell viability was measured using the WST-1 assay. ATP production was determined using the Luciferin-Luciferase assay. Collagen and proteoglycan synthesis were determined by measuring the incorporation of [2, 3-(3)H] proline and [(35)S] sulfate into the cells, respectively.

RESULTS

TMJ disc cell viability significantly decreased (P < 0.0001) without glucose. With glucose present, decreased oxygen levels significantly increased viability (P < 0.0001), while a decrease in glucose concentration significantly decreased viability (P < 0.0001). With glucose present, decreasing oxygen levels significantly reduced ATP production (P < 0.0001) and matrix synthesis (P < 0.0001). A decreased glucose concentration significantly decreased collagen synthesis (P < 0.0001). The interaction between glucose and oxygen was significant in regards to cell viability (P < 0.0001), ATP production (P = 0.00015), and collagen (P = 0.0002) and proteoglycan synthesis (P < 0.0001).

CONCLUSIONS

Although both glucose and oxygen are important, glucose is the limiting nutrient for TMJ disc cell survival. At low oxygen levels, the production of ATP, collagen, and proteoglycan are severely inhibited. These results suggest that steeper nutrient gradients may exist in the TMJ disc and it may be vulnerable to pathological events that impede nutrient supply.

Replacing Shox2 with human SHOX leads to congenital disc degeneration of the temporomandibular joint in mice

The temporomandibular joint (TMJ) consists in the glenoid fossa arising from the otic capsule through intramembranous ossification, the fibrocartilaginous disc and the condyle, which is derived from the secondary cartilage by endochondral ossification. We have reported previously that cranial neural-crest-specific inactivation of the homeobox gene Shox2, which is expressed in the mesenchymal cells of the maxilla-mandibular junction and later in the progenitor cells and perichondrium of the developing chondyle, leads to dysplasia and ankylosis of the TMJ and that replacement of the mouse Shox2 with the human SHOX gene rescues the dysplastic and ankylosis phenotypes but results in a prematurely worn out articular disc. In this study, we investigate the molecular and cellular bases for the prematurely worn out articular disc in the TMJ of mice carrying the human SHOX replacement allele in the Shox2 locus (termed Shox2 (SHOX-KI/KI)). We find that the developmental process and expression of several key genes in the TMJ of Shox2 (SHOX-KI/KI) mice are similar to that of controls. However, the disc of the Shox2 (SHOX-KI/KI) TMJ exhibits a reduced level of Collagen I and Aggrecan, accompanied by increased activities of matrix metalloproteinases and a down-regulation of Ihh expression. Dramatically increased cell apoptosis in the disc was also observed. These combinatory cellular and molecular defects appear to contribute to the observed disc phenotype, suggesting that, although human SHOX can exert similar functions to mouse Shox2 in regulating early TMJ development, it apparently has a distinct function in the regulation of those molecules that are involved in tissue homeostasis.

Relationship between anisotropic diffusion properties and tissue morphology in porcine TMJ disc

OBJECTIVE

To investigate the relationship between anisotropic solute diffusion properties and tissue morphology in porcine temporomandibular joint (TMJ) discs.

DESIGN

TMJ discs from eleven pigs aged 6-8 months were divided into five regions: anterior, intermediate, posterior, lateral, and medial. The transport properties and tissue morphology were investigated in three orthogonal orientations: anteroposterior (AP), mediolateral (ML), and superoinferior (SI). The anisotropic diffusivity of fluorescein (332 Da) in the right discs was determined by the fluorescence recovery after photobleaching (FRAP) protocols. The tissue morphology in the left discs was quantified by scanning electron microscopy.

RESULTS

The diffusivities of fluorescein in the TMJ disc were significantly anisotropic, except for the anterior region. In the medial, intermediate, and lateral regions, the diffusion along the fiber orientation (i.e., AP direction) was significantly faster than the diffusion in ML and SI directions. In the posterior region, the diffusion along the fiber orientation (i.e., ML direction) was significantly faster than the diffusion in AP and SI directions. The diffusion in the anterior region was mostly isotropic with the lowest degree of diffusion anisotropy, as well as collagen fiber alignment, likely due to the multi-directional fiber arrangement. The anterior region had the highest mean diffusivity [65.6 (49.3-81.8) μm(2)/s] in the disc, likely due to its high water content. The overall average diffusivity of fluorescein across the TMJ disc was 57.0 (43.0-71.0) μm(2)/s.

CONCLUSIONS

The solute diffusion in porcine TMJ discs was strongly anisotropic and inhomogeneous, which associated with tissue structure (i.e., collagen fiber alignment) and composition (e.g., water content).

A chondroitinase-ABC and TGF-β1 treatment regimen for enhancing the mechanical properties of tissue-engineered fibrocartilage

The development of functionally equivalent fibrocartilage remains elusive despite efforts to engineer tissues such as knee meniscus, intervertebral disc and temporomandibular joint disc. Attempts to engineer these structures often fail to create tissues with mechanical properties on a par with native tissue, resulting in constructs unsuitable for clinical applications. The objective of this study was to engineer a spectrum of biomimetic fibrocartilages representative of the distinct functional properties found in native tissues. Using the self-assembly process, different co-cultures of meniscus cells and articular chondrocytes were seeded into agarose wells and treated with the catabolic agent chondroitinase-ABC (C-ABC) and the anabolic agent transforming growth factor-β1 (TGF-β1) via a two-factor (cell ratio and bioactive treatment), full factorial study design. Application of both C-ABC and TGF-β1 resulted in a beneficial or positive increase in the collagen content of treated constructs compared to controls. Significant increases in both the collagen density and fiber diameter were also seen with this treatment, increasing these values by 32 and 15%, respectively, over control values. Mechanical testing found the combined bioactive treatment to synergistically increase the Young's modulus and ultimate tensile strength of the engineered fibrocartilages compared to controls, with values reaching the lower spectrum of those found in native tissues. Together, these data demonstrate that C-ABC and TGF-β1 interact to develop a denser collagen matrix better able to withstand tensile loading. This study highlights a way to optimize the tensile properties of engineered fibrocartilage using a biochemical and a biophysical agent together to create distinct fibrocartilages with functional properties mimicking those of native tissue.

Anisotropic solute diffusion tensor in porcine TMJ discs measured by FRAP with spatial Fourier analysis

A new method solely based on spatial Fourier analysis (SFA) was developed to completely determine a two-dimensional (2D) anisotropic diffusion tensor in fibrous tissues using fluorescence recovery after photobleaching (FRAP). The accuracy and robustness of this method was validated using computer-simulated FRAP experiments. This method was applied to determine the region-dependent anisotropic diffusion tensor in porcine temporomandibular joint (TMJ) discs. The average characteristic diffusivity of 4 kDa FITC-Dextran across the disc was 26.05 ± 4.32 μm²/s which is about 16% of its diffusivity in water. In the anteroposterior direction, the anterior region (30.99 ± 5.93 μm²/s) had significantly higher characteristic diffusivity than the intermediate region (20.49 ± 5.38 μm²/s) and posterior region (20.97 ± 2.46 μm²/s). The ratio of the two principal diffusivities represents the anisotropy of the diffusion and ranged between 0.45 and 0.51 (1.0 = isotropic). Our results indicated that the solute diffusion in TMJ discs is inhomogeneous and anisotropic. These findings suggested that diffusive transport in the TMJ disc is dependent on tissue composition (e.g., water content) and structure (e.g., collagen orientation). This study provides a new method to quantitatively investigate the relationship between solute transport properties and tissue composition and structure.

The region-dependent biphasic viscoelastic properties of human temporomandibular joint discs under confined compression

The objective of this study was to determine the biphasic viscoelastic properties of human temporomandibular joint (TMJ) discs, correlate these properties with disc biochemical composition, and examine the relationship between these properties and disc dynamic behavior in confined compression. The equilibrium aggregate modulus (H(A)), hydraulic permeability (k), and dynamic modulus were examined between five disc regions. Biochemical assays were conducted to quantify the amount of water, collagen, and glycosaminoglycan (GAG) content in each region. The creep tests showed that the average equilibrium moduli of the intermediate, lateral, and medial regions were significantly higher than for the anterior and posterior regions (69.75+/-11.47kPa compared to 22.0+/-5.15kPa). Permeability showed the inverse trend with the largest values in the anterior and posterior regions (8.51+/-1.36x10(-15)m(4)/Ns compared with 3.75+/-0.72x10(-15)m(4)/Ns). Discs were 74.5% water by wet weight, 62% collagen, and 3.2% GAG by dry weight. Regional variations were only observed for water content which likely results in the regional variation in biphasic mechanical properties. The dynamic modulus of samples during confined compression is related to the aggregate modulus and hydraulic permeability of the tissue. The anterior and posterior regions displayed lower complex moduli over all frequencies (0.01-3Hz) with average moduli of 171.8-609.3kPa compared with 454.6-1613.0kPa for the 3 central regions. The region of the TMJ disc with higher aggregate modulus and lower permeability had higher dynamic modulus. Our results suggested that fluid pressurization plays a significant role in the load support of the TMJ disc under dynamic loading conditions.

Age-related changes in the microarchitecture of collagen fibrils in the articular disc of the rat temporomandibular joint

The microarchitecture of collagen fibrils in the articular disc of the temporomandibular joint (TMJ) plays an important role in dissipating the mechanical load during jaw movement. However, little information is available on its adaptations to the biomechanical environment during development. To address this issue, we analyzed the diameter of collagen fibrils of the articular disc of the rat TMJ with quantitative ultrastructural analysis during postnatal development. The mean diameter of the collagen fibrils significantly increased and the arrangement of the collagen fiber networks became compact during development. Articular discs of suckling rat pups were composed of thin, uniformly sized collagen fibrils (range: 30-60 nm, peak: 40-50 nm). At the age of 4 weeks, thicker collagen fibrils began to appear in articular discs, shortly after weaning (range: 20-70 nm, peak: 40-50 nm). In articular discs of adult rats, collagen fibrils varied widely in diameter, with thick fibrils predominating (range: 10-120 nm, peak: 40-70 nm). These age-related changes in the microarchitecture of collagen fibrils in articular discs may reflect changes in their biomechanical environment during development.

Tissue Engineering of the TMJ disc: a review

The potential impact of a tissue-engineered temporomandibular joint (TMJ) disc is immense. Currently, patients suffering from a severely dysfunctional TMJ have few options. Facing the general lack of safe, effective TMJ disc implants, many patients undergo discectomy, a procedure that removes the injured TMJ disc in hopes of reducing debilitating symptoms associated with severe TMJ disorders. This procedure may not be ideal as the TMJ is left without an important functional component. Tissue engineering is a promising approach for the creation of viable, effective implants. The first attempt to investigate TMJ disc cells on a biomaterial was conducted in 1991. The first TMJ tissue-engineered constructs to be tested biochemically and biomechanically were formed in 1994; however, in examining this study in retrospect, it is clear how little TMJ knowledge was available at that time. Within the last 10 to 15 years, multiple studies have investigated critical TMJ disc characteristics, and while this characterization is not complete, these data have created a solid foundation for tissue-engineering research. Thus, the last 5 years have yielded core studies investigating the principal elements of tissue engineering: scaffold, cell source, and biological/biomechanical stimuli. Although TMJ disc tissue engineering is still in its formative years, its future is quite promising. Key studies are now being conducted that will assist in the establishment of a solid TMJ disc tissue-engineering approach. As the challenges of tissue engineering are faced and met, the ultimate goal of creating a functional biological implant nears.

Effects of Initial Cell Seeding Density for the Tissue Engineering of the Temporomandibular Joint Disc

Tissue engineering may provide a better treatment modality for postoperative discectomy patients. The TMJ disc is an ideal candidate for tissue engineering approaches because of its lack of an intrinsic regenerative ability. Unfortunately, basic knowledge related to TMJ disc tissue engineering is still at an infancy level and not on par to that related to articular cartilage tissue engineering. The objective of this study was to examine the effects of initial cell density of TMJ disc cells seeded in nonwoven poly-glycolic acid (PGA) scaffolds on the biochemical and biomechanical properties of constructs examined at 0, 3, and 6 weeks after seeding. Low, medium, and high seeding densities were chosen to be 15, 30, and 120 million cells per ml of scaffold, which were seeded using a spinner flask. Significant differences were found temporally and as a function of seeding density in morphology, total collagen, GAG content, and permeability of the constructs, but not in aggregate modulus. The high seeding density group outperformed the low and medium groups in collagen and GAG content at all time points measured. The high-density group produced a total of 55.37 +/- 3.56 microg of collagen per construct, maintained 15.77 +/- 1.86 microg of GAG per construct, and only shrunk to 50% of the original scaffold size. Permeability of the constructs at 6 weeks was decreased by 70% compared to 0 weeks.

Motivation, characterization, and strategy for tissue engineering the temporomandibular joint disc

The purpose of this review is to serve as the standard point of reference in guiding researchers investigating the tissue engineering of the temporomandibular joint (TMJ) disc. Tissue engineering of the TMJ disc is in its infancy, and currently there exists a gap between the tissue engineering community and the TMJ characterization community. The primary goal is to help bridge that gap by consolidating the characterization studies here as a reference to researchers attempting to tissue engineer the TMJ disc. A brief review of TMJ anatomy is provided, along with a description of relevant pathology, current treatment, and a rationale for engineering the TMJ disc. The biochemical composition and organization of the disc are reviewed, including glycosaminoglycan (GAG) and collagen content. The collagen of the disc is almost exclusively type I and primarily runs anteroposteriorly through the center and in a ringlike fashion around the periphery. The GAG content is approximately an order of magnitude less than that of hyaline cartilage, and although the distribution is not entirely clear, it seems as though chondroitin and dermatan sulfate are by far the primary GAGs. Cellular characterization and mechanical properties under compression, tension, and shear are reviewed as well. The cells of the disc are not chondrocytes, but rather resemble fibrocytes and fibrochondrocytes and may be of the same lineage. Mechanically, the disc is certainly anisotropic and nonhomogeneous. Finally, a review of efforts in tissue engineering and cell culture studies of the disc is provided and we close with a description of the direction we envision/propose for successful tissue engineering of the TMJ disc.

Effects of condylar fibrocartilage on the biomechanical loading of the human temporomandibular joint in a three-dimensional, nonlinear finite element model

The present study was undertaken to test a hypothesis that the addition of articular fibrocartilage in the condyle of the temporomandibular joint reduces three-dimensional stress distribution in the condyle, the disc and articular eminence. A three-dimensional, nonlinear finite-element model was developed for analysis of joint loading before and after the addition of condylar fibrocartilage to the osseous mandibular condyle reconstructed from spiral computer topography data. In the model, each of the disc, condyle and articular eminence was arbitrarily divided into five regions: the anterior, posterior, medial, lateral and central. Von Mises stresses that in virtually all regions of the disc, condyle and articular eminence became lower after the addition of condylar fibrocartilage. Especially remarkable was the approximately four-fold reduction in von Mises stresses in the anterior, central and medial regions of the mandibular condyle. In comparison, only slight to moderate stress reductions occurred in the disc and articular eminence, suggesting that condylar fibrocartilage absorbs considerable stresses and likely dampens more loads than the disc and articular eminence. The mandibular condyle demonstrated the largest total displacement in all directions after the addition of articular fibrocartilage, followed by the disc and articular eminence. We conclude that the addition of articular fibrocartilage primarily reduces loading of the mandibular condyle, rather than the disc and articular eminence. These findings lead to a hypothesis that the mandibular condyle more likely functions as a shock absorber than the disc.

Age changes in the cells of the intra-articular disc of the temporomandibular joints of rats and marmosets

Cells in the intra-articular disc of the temporomandibular joint were studied ultrastructurally at three different ages to investigate any age changes. Rats aged 2, 15.5 months, and 2.5 years, and marmosets aged 21 months, 7 years, and between 10.5 and 14 years were studied. In the first two age groups of the rat and the first of the marmoset, the cells were generally rounded and had moderate amounts of rough endoplasmic reticulum and other organelles associated with protein synthesis and secretion. Many cells had conspicuous amounts of microfilamentous material and cell membranes were closely applied to the collagen fibrils of the extracellular matrix. Occasionally, a narrow, irregular space containing microfilamentous material lay adjacent to the cell membrane. In the 2.5-year-old rats and the two older age groups of marmosets, cells with chondrocyte-like morphology were present. These cells were surrounded by a conspicuous pericellular matrix devoid of collagen fibrils and composed of microfilamentous material embedded in an amorphous ground substance. They resembled cells described in fibrocartilage from other sites, but differed from chondrocytes in hyaline cartilage by lacking a pericellular capsule. Thus, rats and marmosets both show cellular age changes in the intra-articular disc of the mandibular joint, which can be considered as changing from fibrous to fibrocartilaginous with age, a condition similar to that reported in humans.

Collagen crimping in the intra-articular disc and articular surfaces of the human temporomandibular joint

The presence of crimping within soft fibrous connective tissues has a considerable role in determining the biomechanical properties of the tissue. However, there is little or no information on crimping of collagen in the human temporomandibular joint. To remedy this situation, the presence and nature of any crimping was studied in sections of human temporomandibular joints from individuals varying in age from between 4.5-63 years, using polarized light microscopy and differential interference contrast microscopy. The presence of crimping was looked for in collagen within the intra-articular disc and the articular surfaces of the mandibular fossa and mandibular condyle. By polarized light, crimping was seen throughout all three tissues at all ages studied. Quantification from micrographs enlarged to x250 showed that the periodicity of the banding (representing half a complete crimp wave) had a mean varying between about 15-20 microm. Crimping was also directly visualized by differential interference contrast microscopy. The presence of such a fundamental feature needs to be considered when explaining the normal function of the temporomandibular joint.

Ultrastructural changes in primary guinea pig osteoarthritis with special reference to collagen

Collagen fibril distribution and surface and volume densities in proximal tibial articular cartilage were measured in 6- and 12-month-old Dunkin-Hartley guinea pigs developing primary osteoarthritis. At 12 months, gross fibrillation and ulceration of the articular cartilage were observed on the medial but not on the lateral condyle. Collagen volume density decreased with age in the interterritorial compartments in the superficial zone, medially by 16% and laterally by 8%. In the upper radial zone, collagen volume density decreased interterritorially by 10% on the medial condyle only. Despite gross osteoarthritic changes, only moderate and predominantly focal ultrastructural collagen changes were observed. Thus neither gross network disruption nor fibril thickening seems to be a general feature in early guinea pig osteoarthritis.

A microscopic and immunocytochemical study of structural changes in dysfunctional human temporomandibular joint discs

The central part of 12 articular discs from patients with serious alterations in function of the temporomandibular joint were investigated. The control discs were removed at autopsy from individuals who did not have any such functional defects. The anomalous discs had an increased cellular component; fibrocytes, fibroblasts, numerous myofibroblasts and, less frequently, smooth muscle cells and mast cells were present. The myofibroblasts, which had numerous bundles of thin filaments in the cytoplasm, were positive to the immunocytochemical reaction with antibody to alpha-smooth muscle actin. In one disc only a large part had changed into a mostly fatty tissue. In the majority of the altered discs, the part examined, which usually is neither vascularized nor innervated, was characterized by the presence of numerous blood vessels. Besides the capillary network several larger vessels were present. In one disc, several myelinated and unmyelinated fibres, isolated or in nerve bundles, were also seen. These observations show that the disc fibrous tissue may undergo deep structural modifications that appear to indicate not only a capacity for repair but also an ability to adapt to new functional conditions.