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Muacevic A, Adler JR, El Asmar EA, Abi Chahine NH. Degenerative Disorder of the Temporomandibular Joint Treated With Autologous Bone Marrow-Derived Stem Cells Using the Regentime Technique: A Case Report. Cureus 2023; 15:e34092. [PMID: 36843829 PMCID: PMC9946899 DOI: 10.7759/cureus.34092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
Temporomandibular joint (TMJ) disease is a type of degenerative musculoskeletal disorder that leads to morphological and functional abnormalities. It has a poorly understood progression with numerous independent and interrelated factors, which makes it difficult for the available treatment options to meet long-term demands. We present the case of a 37-year-old woman who suffered from excruciating pain in the right temporomandibular joint, associated with limited mandibular movement. She was found to have imaging features of TMJ disorder. She underwent the Regentime procedure which uses autologous bone marrow-derived stem cells that are partially differentiated and redirected to the targeted tissue. Clinical follow-up showed total clinical recovery.
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Gögele C, Hoffmann C, Konrad J, Merkel R, Schwarz S, Tohidnezhad M, Hoffmann B, Schulze-Tanzil GG. Cyclically stretched ACL fibroblasts emigrating from spheroids adapt their cytoskeleton and ligament-related expression profile. Cell Tissue Res 2021; 384:675-690. [PMID: 33835257 PMCID: PMC8211585 DOI: 10.1007/s00441-021-03416-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/13/2021] [Indexed: 01/09/2023]
Abstract
Mechanical stress of ligaments varies; hence, ligament fibroblasts must adapt their expression profile to novel mechanomilieus to ensure tissue resilience. Activation of the mechanoreceptors leads to a specific signal transduction, the so-called mechanotransduction. However, with regard to their natural three-dimensional (3D) microenvironment cell reaction to mechanical stimuli during emigrating from a 3D spheroid culture is still unclear. This study aims to provide a deeper understanding of the reaction profile of anterior cruciate ligament (ACL)-derived fibroblasts exposed to cyclic uniaxial strain in two-dimensional (2D) monolayer culture and during emigration from 3D spheroids with respect to cell survival, cell and cytoskeletal orientation, distribution, and expression profile. Monolayers and spheroids were cultured in crosslinked polydimethyl siloxane (PDMS) elastomeric chambers and uniaxially stretched (14% at 0.3 Hz) for 48 h. Cell vitality, their distribution, nuclear shape, stress fiber orientation, focal adhesions, proliferation, expression of ECM components such as sulfated glycosaminoglycans, collagen type I, decorin, tenascin C and cell-cell communication-related gap junctional connexin (CXN) 43, tendon-related markers Mohawk and tenomodulin (myodulin) were analyzed. In contrast to unstretched cells, stretched fibroblasts showed elongation of stress fibers, cell and cytoskeletal alignment perpendicular to strain direction, less rounded cell nuclei, increased numbers of focal adhesions, proliferation, amplified CXN43, and main ECM component expression in both cultures. The applied cyclic stretch protocol evoked an anabolic response and enhanced tendon-related marker expression in ACL-derived fibroblasts emigrating from 3D spheroids and seems also promising to support in future tissue formation in ACL scaffolds seeded in vitro with spheroids.
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Affiliation(s)
- Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof.-Ernst-Nathan Str. 1, 90419 Nuremberg and Salzburg, Nuremberg, Germany
- Department of Biosciences, Paris Lodron University Salzburg, Hellbrunnerstr. 34, 5020 Salzburg, Austria
| | - Christina Hoffmann
- Institute of Biological Information Processing: IBI-2, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Jens Konrad
- Institute of Biological Information Processing: IBI-2, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Rudolf Merkel
- Institute of Biological Information Processing: IBI-2, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Silke Schwarz
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof.-Ernst-Nathan Str. 1, 90419 Nuremberg and Salzburg, Nuremberg, Germany
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany
| | - Bernd Hoffmann
- Institute of Biological Information Processing: IBI-2, Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Gundula Gesine Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Prof.-Ernst-Nathan Str. 1, 90419 Nuremberg and Salzburg, Nuremberg, Germany
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Ooi K, Inoue N, Matsushita K, Mikoya T, Minowa K, Kawashiri S, Tei K. Relations between anterior disc displacement and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle. Br J Oral Maxillofac Surg 2020; 58:1084-1090. [PMID: 32654798 DOI: 10.1016/j.bjoms.2020.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 05/15/2020] [Indexed: 10/23/2022]
Abstract
In this study we investigated the relation between anterior disc displacement (ADD) and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle. Thirty female patients (60 joints) with both conditions were evaluated. Magnetic resonance imaging of the temporomandibular joint (TMJ) was used to diagnose both ADD and changes to the mandibular condyle (erosion, osteophyte, and deformity). The relations among ADD, changes to the mandibular condyle, and maxillomandibular morphology were examined statistically. Changes to the mandibular condyle had a higher score than sym anterior open bite, the deviated side in asymmetric anterior open bite, and the non-deviated side. The score for disc displacement on the non-deviated side was lower than both the sym side and the deviated side. Unilateral changes to the mandibular condyle and unilateral disc displacement were not apparent in sym anterior open bite, but a unilateral non-displaced disc was seen only on the asymmetric side. Mandibular condylar changes were significantly more common on the deviated, than on the non-deviated, side. The SNB angle was significantly smaller, and the ANB, GZN, and SN-mandibular plane angles were significantly larger in sym anterior open bite. Overjet, ANB angle, GZN angle, and SN-MP angle were significantly larger, and the SNB angle was significantly smaller, in the presence of ADD without reduction and mandibular condylar deformity. We conclude that the prevalence of ADD without reduction and changes to the mandibular condyle were related to mandibular asymmetry and mandibular morphology in anterior open bite. This retrospective study suggests that ADD without reduction and mandibular condylar bone changes may be related to the progression of skeletal class II open bite and mandibular asymmetry in cases of skeletal open bite.
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Affiliation(s)
- K Ooi
- Oral and Maxillofacial Surgery, Department of Oral Patho-biological Science, Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7 kita-ku, Sapporo, Hokkaido 060-8586, Japan; Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - N Inoue
- Gerodontology, Department of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7 Kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - K Matsushita
- Oral and Maxillofacial Surgery, Department of Oral Patho-biological Science, Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7 kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - T Mikoya
- Oral and Maxillofacial Surgery, Department of Oral Patho-biological Science, Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7 kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - K Minowa
- Dental Radiology, Department of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7 kita-ku, Sapporo, Hokkaido 060-8586, Japan
| | - S Kawashiri
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - K Tei
- Oral and Maxillofacial Surgery, Department of Oral Patho-biological Science, Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7 kita-ku, Sapporo, Hokkaido 060-8586, Japan
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Conte R, Forin Valvecchi F, Gracco AL, Bruno G, De Stefani A. Condylar dysfunctional remodeling and recortication: a case-control study. MINERVA STOMATOLOGICA 2019; 68:74-83. [PMID: 30854837 DOI: 10.23736/s0026-4970.19.04211-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Temporo-mandibular disorders (TMD) is a collective term comprehending different clinical issues involving masticatory muscles, temporo-mandibular joint (TMJ) and other associated structures. TMD diagnosis is not made for its pathogenesis or etiology, but mainly on clinical symptoms. Primary dysfunction develops mostly on four factors: individual predisposition, high psychomotor activity (due to stress or parafunction), occlusal instability and low or absent tissue adaptation capability. On the other hand, secondary disorders can be caused by hereditary or congenital diseases, rheumatic inflammatory diseases, autoimmune and tumoral diseases. During their function, the condyles undergo a structural adaptive and physiological remodeling, but when mechanical stress exceeds adaptive capability, dysfunctional remodeling phenomena may occur. It is characterized by significant condylar morphological modifications at the level of the head of the condyle (smaller condyle), break of cortical integrity and reduced mandibular ramus height with subsequent mandibular retrusion and articular function alteration. The aim of this study is to compare condylar recortication amount, and pain reduction after two different therapeutic protocols. METHODS This is a case-control study. Twenty TMD patients were chosen and each of them underwent a documentation protocol including extraoral and intraoral photographs, dental casts, casts mounting on the articulator to evaluate CPI (CO-CR discrepancy index) and cone beam computed tomography (CBCT) of the mandibular condyles taken in closed mouth position. For the radiographic evaluation, a Planmeca ProMax 3D Mid system was utilized with an acquiring volume of 80×80 mm dimension, exposition 90 kV, 10.0 mA, 12 seconds with a DAP (Dose Area Product) of 1094 mGy·cm2 for each condyle. The acquired volume was elaborated by the Planmeca Romexis software v. 3.2.0.R and TMJ module. Seven coronal cuts and 10 sagittal cuts were performed on the head of the condyle to highlight the amount of cortication, before and after the application of two different therapeutic protocols. Protocol number 1 (N.=10 patients) included the exclusive use of a splint, while protocol number 2 (N.=10 patients) included the use of a splint associated with pharmacological therapy (NSAIDs, antioxidant, omega 3). The revaluation was performed on asymptomatic patient after a period of 6-8 months. The pain for each patient was assessed by a Visual Analogue Scale (VAS) from 0 to 10, 0 meaning no pain and 10 the worst pain ever felt. The VAS was evaluated after 10 days from the beginning of the treatment, after 3 months and after 8 months at the end of the treatment. Statistical analyses were carried using a χ2 test (P value <0.05). RESULTS No significant differences in the amount of cortication were found in the radiographic revaluation between the two different therapeutic protocols, even though it was noticed that the use of medicaments brought to a resolution of the symptoms in a shorter period of time (P=0.00001 after 10 days; P=0.0251 after 3 months). CONCLUSIONS According to this study, pharmacological protocol in the therapy of TMD does not seem to affect condylar cortication. Medicaments although seem to accelerate the disappearance of clinic symptomatology, but more researches are needed to valid these findings.
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Affiliation(s)
- Roberto Conte
- Department of Neuroscience, University of Padua, Padua, Italy
| | | | | | - Giovanni Bruno
- Department of Neuroscience, University of Padua, Padua, Italy
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Nickel JC, Iwasaki LR, Gonzalez YM, Gallo LM, Yao H. Mechanobehavior and Ontogenesis of the Temporomandibular Joint. J Dent Res 2018; 97:1185-1192. [PMID: 30004817 DOI: 10.1177/0022034518786469] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Craniofacial secondary cartilages of the mandibular condyle and temporomandibular joint (TMJ) eminence grow in response to the local mechanical environment. The intervening TMJ disc distributes normal loads over the cartilage surfaces and provides lubrication. A better understanding of the mechanical environment and its effects on growth, development, and degeneration of the TMJ may improve treatments aimed at modifying jaw growth and preventing or reversing degenerative joint disease (DJD). This review highlights data recorded in human subjects and from computer modeling that elucidate the role of mechanics in TMJ ontogeny. Presented data provide an approximation of the age-related changes in jaw-loading behaviors and TMJ contact mechanics. The cells of the mandibular condyle, eminence, and disc respond to the mechanical environment associated with behaviors and ultimately determine the TMJ components' mature morphologies and susceptibility to precocious development of DJD compared to postcranial joints. The TMJ disc may be especially prone to degenerative change due to its avascularity and steep oxygen and glucose gradients consequent to high cell density and rate of nutrient consumption, as well as low solute diffusivities. The combined effects of strain-related hypoxia and limited glucose concentrations dramatically affect synthesis of the extracellular matrix (ECM), which limit repair capabilities. Magnitude and frequency of jaw loading influence this localized in situ environment, including stem and fibrocartilage cell chemistry, as well as the rate of ECM mechanical fatigue. Key in vivo measurements to characterize the mechanical environment include the concentration of work input to articulating tissues, known as energy density, and the percentage of time that muscles are used to load the jaws out of a total recording time, known as duty factor. Combining these measurements into a mechanobehavioral score and linking these to results of computer models of strain-regulated biochemical events may elucidate the mechanisms responsible for growth, maintenance, and deterioration of TMJ tissues.
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Affiliation(s)
- J C Nickel
- 1 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA.,2 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - L R Iwasaki
- 1 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA.,2 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Y M Gonzalez
- 2 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - L M Gallo
- 3 Department of Masticatory Disorders, University of Zurich School of Dental Medicine, Zurich, Switzerland
| | - H Yao
- 4 Department of Bioengineering, Clemson University, Clemson, SC, USA.,5 Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
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Iwasaki LR, Gonzalez YM, Liu Y, Liu H, Markova M, Gallo LM, Nickel JC. TMJ energy densities in healthy men and women. Osteoarthritis Cartilage 2017; 25:846-849. [PMID: 28064032 PMCID: PMC5438898 DOI: 10.1016/j.joca.2016.12.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/24/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cartilage fatigue, due to mechanical work, may account for the early development of degenerative joint disease (DJD) in the temporomandibular joint (TMJ), and why women are three times more likely to be afflicted. This study tested for gender differences in mechanical energy densities in women and men with healthy TMJs. DESIGN Eighteen women and eighteen men gave informed consent. Research diagnostic criteria including imaging were used to ensure that subjects' TMJs were normal, without disc displacement or signs of DJD. Numerical modeling determined TMJ loads (Fnormal). Jaw tracking and three-dimensional dynamic stereometry characterized individual-specific data of stress-field dynamic mechanics during 10 symmetrical jaw closing cycles. These data were used to estimate tractional forces (Ftraction). Energy densities were then calculated, where: Energy Density = W/Q (W = work done or mechanical energy input = Ftraction*distance of stress-field translation, Q = volume of cartilage). Two-way analysis of variance (ANOVA) and follow-up two-group comparisons tested mean energy densities for ipsilateral and contralateral TMJs in women vs men. RESULTS Mean energy densities ± standard deviations in ipsilateral and contralateral TMJs in women were 9.0 ± 9.7 and 8.4 ± 5.5 mJ/mm3, respectively, and were significantly larger (P = 0.004 and 0.001, respectively) compared to ipsilateral and contralateral TMJs in men, which were 5.6 ± 4.2 and 6.3 ± 4.2 mJ/mm3, respectively. CONCLUSIONS Energy densities were significantly larger in healthy TMJs of women than men. Larger TMJ energy densities during normal jaw functions could predispose earlier mechanical fatigue of the TMJ disc.
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Affiliation(s)
- L R Iwasaki
- University of Missouri-Kansas City, School of Dentistry, Department of Orthodontics & Dentofacial Orthopedics, USA; University of Missouri-Kansas City, School of Dentistry, Department of Oral & Craniofacial Sciences, USA.
| | - Y M Gonzalez
- University at Buffalo, School of Dental Medicine, Department of Oral Diagnostic Sciences, USA.
| | - Y Liu
- East Tennessee State University, Department of Biostatistics & Epidemiology, USA.
| | - H Liu
- University of Missouri-Kansas City, School of Dentistry, Department of Oral & Craniofacial Sciences, USA.
| | - M Markova
- University of Zurich, Center for Dental & Oral Medicine & Oral Maxillofacial Surgery, Clinic for Masticatory Disorders, Switzerland.
| | - L M Gallo
- University of Zurich, Center for Dental & Oral Medicine & Oral Maxillofacial Surgery, Clinic for Masticatory Disorders, Switzerland.
| | - J C Nickel
- University of Missouri-Kansas City, School of Dentistry, Department of Orthodontics & Dentofacial Orthopedics, USA; University of Missouri-Kansas City, School of Dentistry, Department of Oral & Craniofacial Sciences, USA
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7
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Ernberg M. The role of molecular pain biomarkers in temporomandibular joint internal derangement. J Oral Rehabil 2017; 44:481-491. [DOI: 10.1111/joor.12480] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/21/2022]
Affiliation(s)
- M. Ernberg
- Section for Orofacial Pain and Jaw Function; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- The Scandinavian Center for Orofacial Neurosciences (SCON); Huddinge Sweden
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Tanaka E, Yamano E, Dalla-Bona DA, Watanabe M, Inubushi T, Shirakura M, Sano R, Takahashi K, van Eijden T, Tanne K. Dynamic Compressive Properties of the Mandibular Condylar Cartilage. J Dent Res 2016; 85:571-5. [PMID: 16723658 DOI: 10.1177/154405910608500618] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The mandibular condylar cartilage plays an important role as a stress absorber during function. However, relatively little information is available on its dynamic properties under compression. We hypothesized that these properties are region-specific and depend on loading frequency. To characterize the viscoelastic properties of the condylar cartilage, we performed dynamic indentation tests over a wide range of loading frequencies. Ten porcine mandibular condyles were used; the articular surface was divided into 4 regions, anteromedial, anterolateral, posteromedial, and posterolateral. The dynamic complex, storage, and loss moduli increased with frequency, and these values were the highest in the anteromedial region. Loss tangent decreased with frequency from 0.68 to 0.17, but a regional difference was not found. The present results suggest that the dynamic compressive modulus is region-specific and is dependent on the loading frequency, which might have important implications for the transmission of load in the temporomandibular joint.
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Affiliation(s)
- E Tanaka
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan.
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Abstract
During mandibular movement, the geometric relationships of the articular surfaces in the temporomandibular joint (TMJ) change, so that the disc undergoes different stress concentrations with respect to time and position. In this study, we compared the intra-articular space variations of 13 clicking and 15 asymptomatic TMJs for jaw opening/closing. Magnetic resonance imaging and jaw tracking were combined to display the motion of the whole condyle within the fossa. In clicking TMJs, the mediolateral spread s of the stress-field trajectories was 2.4 ± 1.0 mm ( smax = 4.9 ± 2.1 mm) with an aspect ratio a/h of 2.5 ± 1.6, both significantly greater than in controls (p < 0.05). The stress-field trajectories of the controls coincided during opening/closing ( s = 0.9 ± 0.2 mm, smax = 1.8 ± 0.8 mm, a/h = 1.6 ± 0.3). Clicking TMJs showed much less coincident stress-field paths and much “flatter” stress-fields than controls during jaw opening/closing.
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Affiliation(s)
- D B Gössi
- Clinic for Masticatory Disorders and Complete Dentures, Center for Oral Medicine, Dental and Maxillo-Facial Surgery, University of Zürich, Plattenstrasse 11, CH-8028 Zürich, Switzerland
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Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants 2014; 28:e393-414. [PMID: 24278954 DOI: 10.11607/jomi.te20] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Temporomandibular disorders (TMD) are a class of degenerative musculoskeletal conditions associated with morphologic and functional deformities that affect up to 25% of the population, but their etiology and progression are poorly understood and, as a result, treatment options are limited. In up to 70% of cases, TMD are accompanied by malpositioning of the temporomandibular joint (TMJ) disc, termed "internal derangement." Although the onset is not well characterized, correlations between internal derangement and osteoarthritic change have been identified. Because of the complex and unique nature of each TMD case, diagnosis requires patient-specific analysis accompanied by various diagnostic modalities. Likewise, treatment requires customized plans to address the specific characteristics of each patient's disease. In the mechanically demanding and biochemically active environment of the TMJ, therapeutic approaches that can restore joint functionality while responding to changes in the joint have become a necessity. One such approach, tissue engineering, which may be capable of integration and adaptation in the TMJ, carries significant potential for the development of repair and replacement tissues. The following review presents a synopsis of etiology, current treatment methods, and the future of tissue engineering for repairing and/or replacing diseased joint components, specifically the mandibular condyle and TMJ disc. An analysis of native tissue characterization to assist clinicians in identifying tissue engineering objectives and validation metrics for restoring healthy and functional structures of the TMJ is followed by a discussion of current trends in tissue engineering.
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Factors related to the incidence of anterior disc displacement without reduction and bony changes of the temporomandibular joint in patients with anterior open bite. Oral Maxillofac Surg 2013; 18:397-401. [PMID: 23835639 DOI: 10.1007/s10006-013-0424-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We aimed to investigate factors related to the prevalence of anterior disc displacement without reduction (ADDwoR) and bony changes of the condylar head (bony changes) in the temporomandibular joints (TMJs) of patients with anterior open bite. METHODS Subjects are comprised of 36 preoperative patients (72 joints) with skeletal anterior open bite without facial asymmetry who had undergone orthognathic surgery at the Hokkaido University Hospital; magnetic resonance imaging of the TMJ and cephalometric analysis were performed before treatment. Logistic regression analysis was performed to clarify relationships among age, overbite, overjet, ANB angle, sella to nasion (SN) to mandibular plane angle (SN-MP angle), SN to ramus plane angle (GZN angle), gonial angle, and incidence of ADDwoR or bony changes in patients with anterior open bite. RESULTS Fifteen patients had bilateral ADDwoR, and five patients had unilateral ADDwoR; 17 patients had bilateral bony changes, and five patients had unilateral bony changes. SN-MP angle was greater in 20 patients with ADDwoR than that in 16 patients without ADDwoR (p < 0.05). GZN angle was greater in the 20 patients showing bony changes than that in the 16 patients without bony changes (p < 0.05). CONCLUSION In terms of dentofacial morphology, SN-MP angle appears to be associated with the incidence of ADDwoR, and GZN angle appears to be associated with bony changes in the TMJ.
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Farias-Neto A, Martins APVB, Sánchez-Ayala A, Rabie ABM, Novaes PD, Rizzatti-Barbosa CM. The effect of posterior tooth loss on the expression of type II collagen, IL-1β and VEGF in the condylar cartilage of growing rats. Arch Oral Biol 2012; 57:1551-7. [DOI: 10.1016/j.archoralbio.2012.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 05/04/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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13
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Yáñez-Vico RM, Iglesias-Linares A, Torres-Lagares D, Gutiérrez-Pérez JL, Solano-Reina E. Association between craniofacial asymmetry and unilateral temporomandibular joint sounds in adult patients using 3D-computed tomography. Oral Dis 2012; 19:406-14. [PMID: 23034131 DOI: 10.1111/odi.12020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 08/28/2012] [Accepted: 08/31/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the possible relationship between unilateral temporomandibular joint (TMJ) sounds and craniofacial asymmetry, using 3D-computed tomography (CT) measurements. SUBJECTS AND METHODS Forty-one reconstructed 3D-CT models of adult subjects were measured to analyze craniofacial asymmetry. Subjects were divided into two groups depending on the presence (n = 20) or absence (n = 21) of unilateral joint sounds, and the results compared using the Mann-Whitney U-test. To investigate the association between these parameters, the Pearson correlation coefficient was calculated. RESULTS Asymmetries in the maxillary and mandibular structures were statistically significant (P < 0.05) for subjects with unilateral TMJ sounds and for controls, except in the case of maxillary rotation and mandibular ramus height (P > 0.05). The highest deviations found were frontal and lateral ramal inclination, goniac angle and canting of occlusal plane. CONCLUSIONS Adult patients with unilateral joint sounds may have skeletal jaw asymmetry and a canted occlusal plane.
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Affiliation(s)
- R-M Yáñez-Vico
- Division of Orthodontics and Dentofacial Orthopaedics, Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain
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Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings. J Craniomaxillofac Surg 2012; 40:283-6. [DOI: 10.1016/j.jcms.2011.04.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/15/2011] [Accepted: 04/08/2011] [Indexed: 11/20/2022] Open
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Wang XD, Kou XX, Mao JJ, Gan YH, Zhou YH. Sustained inflammation induces degeneration of the temporomandibular joint. J Dent Res 2012; 91:499-505. [PMID: 22427270 DOI: 10.1177/0022034512441946] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The temporomandibular joint (TMJ) undergoes degenerative changes among patients who suffer from arthritis, and yet the pathogenesis of TMJ osteoarthritis and rheumatoid arthritis is poorly understood. We hypothesized that sustained inflammation in the TMJ induces structural abnormalities, and accordingly characterized the disc and synovium in a novel model with double injections of complete Freund's adjuvant (CFA), using behavioral, morphological, cellular, and molecular assessments. Thirty-five days following double CFA injections in seven-week-old female Sprague-Dawley rats, the disc in the CFA-induced inflammation group demonstrated multiple degenerative changes, including marked thickening, opacity, and deformation. The discs in the CFA group further showed significantly greater wet and net weights, and elevated collagen, aggrecan, and total glycosaminoglycan contents. The synovium in the CFA-induced inflammation group showed marked infiltration of mononucleated cells and accumulated sub-synovial adipose tissue. Both the disc and synovium had significantly higher iNOS and IL-1β mRNA expression than controls (saline injections). These findings are consistent with our hypothesis that sustained TMJ inflammation, even within the presently observed 35 days, may be a predisposing factor for structural abnormalities. Insight into TMJ inflammation and degeneration is anticipated to improve our understanding of the pathogenesis of TMJ arthritis and help design clinically relevant strategies for tissue engineering.
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Affiliation(s)
- X D Wang
- Department of Orthodontics, Peking University School & Hospital of Stomatology, 22# Zhongguancun South Ave., Beijing, China
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Galhardo MS, Caldini EG, Battlehner CN, Toledo OMS. Age-dependent physiological changes in the histoarchitecture of the articular cartilage of the rabbit mandibular condyle: a morphological and morphometric study. Cells Tissues Organs 2011; 195:340-52. [PMID: 21893930 DOI: 10.1159/000327722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2011] [Indexed: 11/19/2022] Open
Abstract
Mandibular condyle articular cartilage participates in condylar postnatal growth and is responsible for adaptations to anatomical and/or biomechanical alterations throughout life. In a preliminary study in rabbits, differences were observed in the thickness of the layers of articular cartilage in control animals at 5 and 6 months (generally considered adults for this purpose). This study aimed to describe sagittally sectioned condylar cartilages stained with Picrosirius-hematoxylin in rabbits at 40 days and 5, 6, 8, 13, and 18 months to determine when histological maturity is reached. At 40 days, 5 layers were seen: fibrous, proliferative, transition, maturation, and hypertrophic. Older animals (5-18 months) lacked the transition layer. Fibrous, proliferative, and hypertrophic regions were considered for morphometric analysis. The thickness of the fibrous region did not change during the analyzed period (p = 0.1899). When proliferative and hypertrophic regions and the total thickness of the cartilage were compared, a difference was detected (p < 0.001). The thickness of the proliferative region was greatest at 40 days and decreased at 5 months; however, it increased at 6 months, when it was significantly thicker than at 5, 8, 13, and 18 months. Both the hypertrophic region and the total thickness were thickest at 40 days, intermediate at 5, 6, and 8 months, and thinnest at 13 and 18 months. In summary, our data suggest a physiological period of increased cartilage growth at 6 months. Additionally, rabbits at this age should be avoided in experiments involving condylar cartilage. Finally, 13-month-old rabbits have reached histological maturity of the condylar cartilage.
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Güler N, Kürkçü M, Duygu G, Cam B. Sodium iodoacetate induced osteoarthrosis model in rabbit temporomandibular joint: CT and histological study (part I). Int J Oral Maxillofac Surg 2011; 40:1289-95. [PMID: 21885247 DOI: 10.1016/j.ijom.2011.07.908] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 06/05/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
Abstract
Studies to elucidate the pathophysiology of osteoarthrosis have been hampered by the lack of a rapid, reproducible animal model that mimics the histopathology and symptoms associated with the disease. The aim of this study is to evaluate the radiological, histological and histomorphometrical findings of four different concentrations of sodium iodoacetate (MIA) to create osteoarthrosis by using an arthrocentesis technique on rabbit temporomandibular joint (TMJ). 12 New Zealand white male rabbits received an injection of MIA (50 μl dose of 1.5, 2, 2.5, 3mg/ml concentrations) to a single joint of each group by arthrocentesis. Computed tomography (CT) images were obtained pre- and post-injections at 2, 4 and 6 weeks. Early osteoarthritic changes in the rabbit TMJ were found histologically at 4 weeks and with a 3mg/ml concentration of MIA. The mean subchondral bone volume depended on the concentration of MIA and was 62±2.6%, 63±4.1%, 42±3.6% and 38±3.8%, respectively. A minor abnormality was found on CT in six joints at the 4-week follow up. MIA injection and arthrocentesis offer a rapid and minimally invasive method of reproducing histologically osteoarthrotic lesions in the rabbit TMJ.
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Affiliation(s)
- N Güler
- Yeditepe University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey.
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Abstract
To investigate the extracellular matrices in the primo-nodes (PNs) and vessels (PVs) (Bonghan corpuscles and ducts), fine structure of the fibers comprising the extracellular matrices was studied in relation to the diameter and the periodicity to identify the types of the fibers. Electron micrographs of the fibers from the previously published works on the PNs and PVs were analyzed by using MATLAB programming and ImageJ software. The extracellular fibrous components of the PNs and PVs could be classified generally into two groups--thin collagen fibrils and thick non-collagenous wavy bent fibers. The thick bent fibers were fibrin-like. The diameters of the thick bent fibers were 30-200 nm and they were highly bent. This group included organ surface PNs and lymphatic PNs/PVs. The diameters of the collagen fibrils were 30-70 nm. Organ surface, heart, and hypodermis PVs were categorized in this group. The periodicity of bent fibers in an organ surface PN was 16.1 +/- 0.2 (SE) nm, and the periodicity of collagen fibrils in the hypodermis PVs was 37.4 +/- 0.5 (SE) nm. Further investigations are required to reveal the physiological implications of the two types of fibers in the PNs and PVs.
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Affiliation(s)
- Jong Hyun Jung
- Biomedical Physics Laboratory, Department of Physics and Astronomy, Seoul National University, Seoul, Korea.
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Feng J, Gu Z, Lin X, Fan Y. Postnatal development of type II collagen and aggrecan mRNA expression in a rabbit craniomandibular joint. Anat Rec (Hoboken) 2010; 293:1574-80. [PMID: 20652943 DOI: 10.1002/ar.21200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to investigate the postnatal growth changes in the condyle and disc of the rabbit craniomandibular joint (CMJ). Forty-eight rabbits from newborn to an age of 120 days were divided into eight groups, and chondrocytic differentiation and function were evaluated within the CMJ by in situ hybridization of type II collagen and aggrecan mRNA. The morphology of the posterior band and the bilaminar zone were similar in the newborn group and were composed primarily of mesenchymal cells and capillaries. After weaning, mastication loading induced the differentiation of mesenchymal cells, which was accompanied by structural differentiation between the posterior band and the bilaminar zone. Aggrecan first appeared in the posterior band of the disc at 30 days postnatally, when the rabbits began to masticate solid food. Type II collagen emerged in the disc at the age of 45 days. Both genes coexpressed in the deeper half of the proliferative layer, the whole hypertrophic layer, and the mineralized layer of the condylar cartilage and staining intensity increased with age. The coexpression of aggrecan and Type II collagen indicates the maturation of chondrocyte differentiation in the disc and condyle, which contributes to the biomechanical characteristics of the CMJ that resist functional stimulation.
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Affiliation(s)
- Jianying Feng
- Department of Orthodontics, Hospital of Stomatology, Zhejiang University, People's Republic of China
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Tanaka E, Detamore M, Mercuri L. Degenerative Disorders of the Temporomandibular Joint: Etiology, Diagnosis, and Treatment. J Dent Res 2008; 87:296-307. [DOI: 10.1177/154405910808700406] [Citation(s) in RCA: 470] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Temporomandibular joint (TMJ) disorders have complex and sometimes controversial etiologies. Also, under similar circumstances, one person’s TMJ may appear to deteriorate, while another’s does not. However, once degenerative changes start in the TMJ, this pathology can be crippling, leading to a variety of morphological and functional deformities. Primarily, TMJ disorders have a non-inflammatory origin. The pathological process is characterized by deterioration and abrasion of articular cartilage and local thickening. These changes are accompanied by the superimposition of secondary inflammatory changes. Therefore, appreciating the pathophysiology of the TMJ degenerative disorders is important to an understanding of the etiology, diagnosis, and treatment of internal derangement and osteoarthrosis of the TMJ. The degenerative changes in the TMJ are believed to result from dysfunctional remodeling, due to a decreased host-adaptive capacity of the articulating surfaces and/or functional overloading of the joint that exceeds the normal adaptive capacity. This paper reviews etiologies that involve biomechanical and biochemical factors associated with functional overloading of the joint and the clinical, radiographic, and biochemical findings important in the diagnosis of TMJ-osteoarthrosis. In addition, non-invasive and invasive modalities utilized in TMJ-osteoarthrosis management, and the possibility of tissue engineering, are discussed.
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Affiliation(s)
- E. Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, The University of Tokushima Graduate School of Oral Sciences, 3-18-15 Kuramoto-cho, Tokushima 770-8504, Japan
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS, USA; and
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - M.S. Detamore
- Department of Orthodontics and Dentofacial Orthopedics, The University of Tokushima Graduate School of Oral Sciences, 3-18-15 Kuramoto-cho, Tokushima 770-8504, Japan
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS, USA; and
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - L.G. Mercuri
- Department of Orthodontics and Dentofacial Orthopedics, The University of Tokushima Graduate School of Oral Sciences, 3-18-15 Kuramoto-cho, Tokushima 770-8504, Japan
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS, USA; and
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
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A histochemical survey of the human temporomandibular joint disc of patients with internal derangement without reduction. J Craniofac Surg 2008; 18:1429-33. [PMID: 17993895 DOI: 10.1097/scs.0b013e31814fb72a] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study describes, microscopically, the pathologic findings correlated to malpositioning of the human temporomandibular joint disc. The specimens studied consisted of 21 discs removed from patients affected by temporomandibular joint arthropathy. The specimens were cut longitudinally and were fixed overnight in 10% neutral-buffered formalin. They were embedded in paraffin with anatomic orientation preserved. Three- to 4-microm thick sections were cut according to routine procedures and mounted on slides. Then they were stained with Goldner-modified-Mallory staining used for morphologic study at light microscopy. Abnormal collagen fiber arrangements, fragmentation of collagen fibrils, new vessel formation, meniscal tears, mucoid degeneration of the disc matrix, chondrocyte-like cells proliferation, sometimes with clonal aggregation, and hyalinization were detected in temporomandibular joint disc specimens with internal derangement, although with a different extent. From our observations, it seems that in most cases, the temporomandibular joint disc responded to internal derangement without reduction with a fragmentation of collagen fibers because hyalinization of disc matrix occurred very rarely. Moreover, disc derangement without reduction is characterized also by a change in cell population phenotype.
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Tanaka E, Rego EB, Iwabuchi Y, Inubushi T, Koolstra JH, van Eijden TMGJ, Kawai N, Kudo Y, Takata T, Tanne K. Biomechanical response of condylar cartilage-on-bone to dynamic shear. J Biomed Mater Res A 2008; 85:127-32. [PMID: 17688244 DOI: 10.1002/jbm.a.31500] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Shear stress can result in fatigue, damage, and irreversible deformation of the mandibular condylar cartilage. However, little information is available on its dynamic properties in shear. We tested the hypothesis that the dynamic shear properties of the condylar cartilage depend on the frequency and amplitude of shear strain. Ten porcine mandibular condyles were used for dynamic shear tests. Two cartilage-bone plugs were dissected from each condyle and tested in a simple shear sandwich configuration under a compressive strain of 10%. Sinusoidal shear strain was applied with an amplitude of 1.0, 2.0, and 3.0% and a frequency range between 0.01 and 10 Hz. The magnitudes of the shear dynamic moduli were found to be dependent on the frequency and the shear strain amplitude. They increased with shear strain. tan delta ranged from 0.2 to 0.4, which means that the cartilage is primarily elastic in nature and has a small but not negligible viscosity. In conclusion, the present results show that the shear behavior of the mandibular condylar cartilage is dependent on the frequency and amplitude of the applied shear strain. The observed shear characteristics suggest a significant role of shear strain on the interstitial fluid flow within the cartilage.
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Affiliation(s)
- Eiji Tanaka
- Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
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Muhonen A, Säämänen AM, Peltomäki T, Happonen RP. The effect of irradiation and hyperbaric oxygenation (HBO) on extracellular matrix of the condylar cartilage after mandibular distraction osteogenesis in the rabbit. Int J Oral Maxillofac Surg 2006; 35:79-87. [PMID: 16188425 DOI: 10.1016/j.ijom.2005.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 04/27/2005] [Accepted: 06/13/2005] [Indexed: 10/25/2022]
Abstract
The effects of irradiation and hyperbaric oxygenation (HBO) on the extracellular matrix of condylar cartilage after mandibular distraction were evaluated. Unilateral distraction was performed on 19 rabbits. Five study groups were included: control, low- and high-dose irradiation, and low- and high-dose irradiation groups with HBO. Additionally, four temporomandibular joints (TMJ) were used as control material. The high-dose irradiated animals were given in the TMJ 22.4 Gy/4 fractions irradiation (equivalent to 50 Gy/25 fractions). Low-dose irradiation group received a 2.2 Gy dosage. Two groups were also given preoperatively HBO 18 x 2.5ATA x 90 min. After a two-week distraction period (14 mm lengthening) and four-week consolidation period the TMJs were removed. Proteoglycan (PG) distribution of the extracellular matrix was evaluated using safranin O staining and collagen I and II using immunohistochemistry. The organization of fibrillar network was studied by polarized light microscopy. On the operated side of the control group and on the unoperated side in all, except for high-dose irradiated group, PG distribution and fibrillar network were normal appearing. In the irradiated groups, with or without HBO, the cartilaginous layer was partially or totally devoid of PG and the network structure was severely damaged. In conclusion, irradiation in conjunction with the pressure applied by distraction causes severe damage to extracellular matrix of condylar cartilage.
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Affiliation(s)
- A Muhonen
- Department of Oral and Maxillofacial Surgery, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland.
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Gallo LM. Modeling of Temporomandibular Joint Function Using MRI and Jaw-Tracking Technologies – Mechanics. Cells Tissues Organs 2005; 180:54-68. [PMID: 16088134 DOI: 10.1159/000086199] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The study of mechanics of the temporomandibular joint (TMJ) is important because its dysfunction and breakdown could be, at least partially, of mechanical origin. The incongruity of the articular surfaces of the TMJ is compensated by a fibrocartilaginous articular disc. Its dislocation and failure seem to be closely related to the development of osteoarthritis of the TMJ. The analysis of mandibular kinematics permits the detection and assessment of irregularities of TMJ function due to internal obstacles such as a displaced articular disc. Furthermore, the measurement of the dynamic relationship between the articular surfaces of the TMJ is useful to determine the strains undergone by the disc that if too high might compromise its integrity. The development of our research in TMJ mechanics has evolved from the acquisition of the traces of single mandibular points to an accurate and compact description of mandibular motion, in which the mechanical advantage of jaw muscles, and forces and torques acting on the jaw are considered as well. The combination of three-dimensional software models of TMJ anatomies obtained from MRI and jaw tracking with six degrees of freedom permits a subject-specific dynamic analysis of the intra-articular space, providing insight into individual disc deformation during function and TMJ loading. Studies performed with this system indicate that both TMJs are loaded during chewing, the balancing more so than the working joint. In fact, during chewing, the intra-articular distance is smaller for hard than for soft food, on closing than on opening, on the balancing than on the working side. This last finding is confirmed by static biting experiments, in which the condyle-fossa distance decreases more on the side contralateral to the bite force, depending on its magnitude. Also studies on the dynamics of compression areas indicate that plowing can occur through the disc during function, especially mediolaterally, due to stress field translation. This effect might contribute to cartilage wear and fatigue also because the disc is weaker mediolaterally. Further data indicate that the lateral area of the disc is mostly exposed to a higher mechanical energy density. This will be more intensively investigated using finite element method.
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Affiliation(s)
- Luigi M Gallo
- Clinic for Masticatory Disorders and Complete Dentures, Center for Oral Medicine, Dental and Maxillofacial Surgery, University of Zurich, Zurich, Switzerland.
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