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Zhang D, Abdelrehem A, Luo Y, Shen P, Yang C. Effect of arthroscopic discopexy on condylar growth in adolescents with temporomandibular joint disc displacement without reduction: A retrospective self-controlled case series study. J Craniomaxillofac Surg 2024; 52:157-164. [PMID: 37925338 DOI: 10.1016/j.jcms.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 05/06/2023] [Accepted: 06/25/2023] [Indexed: 11/06/2023] Open
Abstract
This study was a retrospective self-controlled study that aimed to evaluate the effect of arthroscopic discopexy on condylar height and mandibular position in adolescents with temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR). Patients between 10 and 20 years of age and diagnosed with bilateral TMJ ADDwoR by magnetic resonance image (MRI) were included in this study. All patients underwent a period of natural course before arthroscopic surgery and then a follow-up period postoperatively. Changes in condylar height and mandibular position were measured by MRI and X-ray radiographs. Data were analyzed by paired t-test, Pearson correlation analysis, and generalized estimating equations. This study comprised a total of 40 patients with a mean age of 14.80 years. Pearson correlation analysis showed correlations between condylar height and mandibular position changes. The condylar height change during the post-operative period was significantly higher than that during natural course period (3.57 mm, p < 0.001). The changes in mandibular position (including ANB angle, SNB angle, and Pog-Np) were significant different (all p < 0.05) between the two periods. This study found that arthroscopic discopexy can promote condylar growth and correct dentofacial deformity in adolescents with bilateral TMJ ADDwoR.
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Affiliation(s)
- Dahe Zhang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Alexandria University, Alexandria, 21563, Egypt
| | - Yi Luo
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China
| | - Pei Shen
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China.
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China.
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Nickel J, Gonzalez Y, Wu Y, Liu Y, Liu H, Iwasaki L. Chronic Pain-Related Jaw Muscle Motor Load and Sensory Processing. J Dent Res 2022; 101:1165-1171. [PMID: 35708459 PMCID: PMC9403723 DOI: 10.1177/00220345221099885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic pain associated with temporomandibular disorders (TMDs) may reflect muscle mechanoreceptor afferent barrage and dysregulated sensory processing. This observational study tested for associations between Characteristic Pain Intensity (CPI), physical symptoms (Patient Health Questionnaire-15 [PHQ-15]), and cumulative jaw muscle motor load (mV*s). In accordance with institutional review board oversight and Strengthening the Reporting of Observational Studies in Epidemiology guidelines, adult subjects gave informed consent and were identified via Diagnostic Criteria for TMD (DC-TMD) examination and research protocols. Subjects were assigned to ±Pain groups using DC-TMD criteria for myalgia. CPI scores characterized pain intensity. PHQ-15 scores were surrogate measures of dysregulated sensory processing. Laboratory tests were performed to quantify masseter and temporalis muscle activities (mV) per bite force (N) for each subject. In their natural environments, subjects recorded day- and nighttime electromyography from which cumulative jaw muscle motor loads (mV*s) were determined for activities consistent with bite forces of >1 to ≤2 and >2 to ≤5 N. Data were assessed using univariate analysis of variance, simple effects tests, K-means cluster classification, and 3-dimensional regression analyses. Of 242 individuals screened, 144 enrolled, and 125 with complete data from study protocols, there were 35 females and 15 males for +Pain and 35 females and 40 males for -Pain. Subjects produced 324 daytime and 341 nighttime recordings of average duration 6.9 ± 1.7 and 7.6 ± 1.7 h, respectively. Overall, +Pain compared to -Pain subjects had significantly higher (all P ≤ 0.002) CPI and PHQ-15 scores. Cumulative jaw muscle motor loads showed significant between-subject effects for time, diagnostic group, and sex (all P < 0.003), where motor loads tended to be higher for daytime versus nighttime, +Pain versus -Pain groups, and males versus females. Two clusters were identified, and regression relations showed associations of low-magnitude daytime masseter motor load, PHQ-15, and CPI scores for cluster 1 (n = 105, R2 = 0.44) and cluster 2 (n = 18, R2 = 0.80). Furthermore, these regression relations showed thresholds of motor load and PHQ-15 scores, above which there were nonlinear increases in reported pain.
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Affiliation(s)
- J.C. Nickel
- Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Y.M. Gonzalez
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Y. Wu
- Department of Integrative Biomedical and Diagnostic Sciences, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Y. Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - H. Liu
- Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - L.R. Iwasaki
- Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
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Ramanan D, Palla S, Bennani H, Polonowita A, Farella M. Oral behaviours and wake-time masseter activity in patients with masticatory muscle pain. J Oral Rehabil 2021; 48:979-988. [PMID: 34185872 DOI: 10.1111/joor.13219] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/06/2021] [Accepted: 06/24/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Little is known about wake-time masseter activity of patients with masticatory muscle pain in real-life settings. OBJECTIVES The aims of this study were (1) to assess wake-time masseter activity of women with masticatory muscle pain (MMP) and compare it with that of pain-free women; and (2) to investigate the association between objectively measured masseter contractions and self-reported oral behaviours. METHODS Adult women (N = 27) diagnosed with MMP were age-matched with pain-free women (N = 26). The electromyographic (EMG) activity of the masseter muscle when awake was recorded unilaterally for two consecutive days. The number of contraction episodes and relative contraction time (%) were calculated using cut-off thresholds of 3%, 5% and 10% of maximum voluntary contraction (MVC). Self-reported daytime oral activity was assessed using the Oral Behaviours Checklist (OBC, items 3-21). Data were analysed using univariate tests and mixed-model analyses. RESULTS The number of contraction episodes was similar between groups for all detection thresholds, but the relative contraction time at the lower detection thresholds (i.e. 3% MVC and 5% MVC) was significantly longer (1.5-fold) in the MMP than in the pain-free group. The OBC scores were significantly higher in the women with MMP than in controls, but no positive association could be found between EMG variables and OBC scores. CONCLUSION Women with MMP engage in low-level masseter muscle contractions, which last longer than those of pain-free controls. There was no relationship between self-reported oral behaviours and masseter activity when awake. These findings support the notion that prolonged low-level clenching when awake may play a role in the pathophysiology of MMP.
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Affiliation(s)
- D Ramanan
- Discipline of Orthodontics, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - S Palla
- University of Zurich, Zurich, Switzerland
| | - H Bennani
- Discipline of Orthodontics, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - A Polonowita
- Discipline of Oral Medicine, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - M Farella
- Discipline of Orthodontics, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand.,Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Riddle PC, Nickel JC, Liu Y, Gonzalez YM, Gallo LM, Conley RS, Dunford R, Liu H, Iwasaki LR. Mechanobehavior and mandibular ramus length in different facial phenotypes. Angle Orthod 2020; 90:866-872. [PMID: 33378519 DOI: 10.2319/032420-217.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To test the hypotheses that mechanobehavior scores (MBS) were correlated with mandibular ramus lengths (Co-Go) and differed between facial phenotypes. MATERIALS AND METHODS Subjects gave informed consent to participate. Co-Go (mm), mandibular plane angles (SN-GoGn, °), and three-dimensional anatomy were derived from cephalometric radiography or cone beam computed tomography. Temporomandibular joint (TMJ) energy densities (ED) (mJ/mm3) were measured using dynamic stereometry and duty factors (DF) (%) were measured from electromyography, to calculate MBS (= ED2 × DF,) for each TMJ. Polynomial regressions, K-means cluster analysis, and analysis of variance (ANOVA) with Tukey post-hoc tests were employed. RESULTS Fifty females and 23 males produced replete data. Polynomial regressions showed MBS were correlated with Co-Go (females, R2 = 0.57; males, R2 = 0.81). Cluster analysis identified three groups (P < .001). Dolichofacial subjects, with shorter normalized Co-Go, clustered into two subgroups with low and high MBS compared to brachyfacial subjects with longer Co-Go. SN-GoGn was significantly larger (P < .03) in the dolichofacial subgroups combined (33.0 ± 5.9°) compared to the brachyfacial group (29.8 ± 5.5°). CONCLUSIONS MBS correlated with Co-Go within sexes and differed significantly between brachyfacial and dolichofacial subjects.
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Pelai EB, Foltran-Mescollotto F, de Castro-Carletti EM, de Moraes M, Rodrigues-Bigaton D. Comparison of the pattern of activation of the masticatory muscles among individuals with and without TMD: A systematic review. Cranio 2020; 41:102-111. [PMID: 33073743 DOI: 10.1080/08869634.2020.1831836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To verify the characteristics of the electromyographic signal of masticatory muscles in individuals with TMD and asymptomatic individuals. METHODS A systematic review was carried out, selecting cross-sectional studies with at least one electromyographic parameter (FM; iEMG; RMS) of the masticatory muscles (anterior temporal, bilateral masseter, and suprahyoid muscles) of individuals with TMD compared to asymptomatic individuals. RESULTS This review identified 1656 titles, of which 30 articles were included in the final analysis. It was observed that the data referring to the pattern of activation of masticatory muscles in the rest, isometry, and isotonic conditions of individuals with TMD are heterogeneous. This fact may be related to variability in the methods and analyses applied in the studies. CONCLUSION Data referring to the pattern of activation of masticatory muscles in the rest and isometry conditions and in the mastication cycle of individuals with TMD and asymptomatic individuals are diverse.
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Affiliation(s)
- Elisa Bizetti Pelai
- Post-Graduate Program in Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
| | - Fabiana Foltran-Mescollotto
- Graduate Program in Human Movement Sciences, Methodist University of Piracicaba - UNIMEP, Piracicaba, Brazil
| | | | - Marcio de Moraes
- Post-Graduate Program in Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
| | - Delaine Rodrigues-Bigaton
- Post-Graduate Program in Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
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MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder. Oral Radiol 2020; 37:469-475. [PMID: 32946019 DOI: 10.1007/s11282-020-00483-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint. METHODS MRI studies of 219 subjects with symptoms of unilateral TMD were examined for signs of disc displacement, osteoarthritis, disc deformation, and effusion in both temporomandibular joints (TMJ). The Chi-Square test and stepwise logistic regression analysis were performed. RESULTS Disc displacement, osteoarthritis, disc deformation, and effusion were more common on the symptomatic side. However, in the category of disc displacement with a reduction in open mouth position (DDWR), the difference was not significant between the symptomatic and the asymptomatic TMJs. Stepwise logistic regression showed that the presence of any imaging abnormality other than DDWR was related to osteoarthritis and disc deformity on the symptomatic side. On the other hand, the presence of any MRI abnormality (including DDWR) on the asymptomatic side was related only to the presence of osteoarthritis on the symptomatic side. CONCLUSIONS Unilateral symptomatic TMD is related to the presence of imaging abnormalities on the contralateral, asymptomatic side, suggesting that the development and progression of joint changes in symptomatic and contralateral asymptomatic TMJs are interrelated.
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Evaluation the effects of low-level laser therapy on disc displacement with reduction. Turk J Phys Med Rehabil 2020; 66:24-30. [PMID: 32318671 DOI: 10.5606/tftrd.2020.3355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/04/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the effects of additional low-level laser therapy (940 nm GaAlAs) to the routine occlusal splint therapy on maximal mouth opening (MMO), visual analog scale (VAS) scores, and passive mouth opening (PMO). Patients and methods Between January 2016 and March 2018, a total of 40 patients (10 males, 30 females; mean age 22.35 years; range, 18 to 60 years) with disc displacement with reduction of the temporomandibular joint were included. The patients were divided into two groups. Group 1 (control group, n=20) received routine non-steroidal anti-inflammatory drug (NSAID) therapy and occlusal splint therapy for eight hours per day for a total of three months. Group 2 (laser group, n=20) received NSAID, occlusal splint therapy and 940 nm wavelength diode laser therapy for two sessions per week for a total of four weeks. The MMO, PMO, and VAS scores were recorded before and at one, two, three, four, and 12 weeks after treatment. The joint and muscle examinations were performed. Results A constant decrease was found in the VAS scores in both groups. At four (p=0.008) and 12 weeks (p=0.003), a statistically significant difference in the VAS scores was observed. At all time points, PMO and MMO scores increased in both groups. The MMO scores were statistically higher in the laser group at all time points (p<0.005). Conclusion Our study results suggest that short-term low-level laser therapy additional to conventional treatment may yield satisfactory outcomes.
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8
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Paluch Ł, Maj P, Pietruski P, Korba M, Noszczyk BH. Shear Wave Elastography in the Evaluation of Temporomandibular Joint Disorders. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:46-54. [PMID: 31635758 DOI: 10.1016/j.ultrasmedbio.2019.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
We aimed at verifying the usefulness of shear wave elastography in determining the temporomandibular disc stiffness in patients with a temporomandibular disorders (TMDs). The study included 37 patients with confirmed TMDs and 208 healthy volunteers. Patients presented with significantly greater stiffness of the intermediate zone of the disc (region of interest [ROI] 1) and significantly lower stiffness of its anteriorly displaced portion (ROI 3). A receiver operating characteristics analysis indicated that a decrease in the stiffness in ROI 3 less than 8.667 KPa provided 100% sensitivity, 97.3% specificity, 100% positive predictive value (PPV) and 99.5% negative predictive value (NPV) in distinguishing between patients with TMDs and without. Whereas an increase in ROI 1 stiffness to at least 54.33 KPa provided high specificity and NPV, both the sensitivity and the PPV of this predictor equaled zero. Findings suggest that a decrease in anteriorly dislocated disc stiffness less than 8.667 kPa can accurately identify patients with TMDs.
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Affiliation(s)
- Łukasz Paluch
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
| | - Paulina Maj
- Department of Head and Neck Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Pietruski
- Department of Plastic Surgery, Orłowski Hospital, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Korba
- Department of Cranio-Maxillofacial Surgery, Oral Surgery and Implantology, Medical University of Warsaw, Poland
| | - Bartłomiej H Noszczyk
- Department of Plastic Surgery, Orłowski Hospital, Center of Postgraduate Medical Education, Warsaw, Poland.
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9
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Almarza AJ, Mercuri LG, Arzi B, Gallo LM, Granquist E, Kapila S, Detamore MS. Temporomandibular Joint Bioengineering Conference: Working Together Toward Improving Clinical Outcomes. J Biomech Eng 2019; 142:2737113. [PMID: 31233104 DOI: 10.1115/1.4044090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 12/21/2022]
Abstract
The sixth temporomandibular joint (TMJ) Bioengineering Conference (TMJBC) was held on June 14-15 2018, in Redondo Beach, California, 12 years after the first TMJBC. Speakers gave 30 presentations and came from the United States, Europe, Asia, and Australia. The goal of the conference has remained to foster a continuing forum for bioengineers, scientists, and surgeons and veterinarians to advance technology related to TMJ disorders. These collective multidisciplinary interactions over the past decade have made large strides in moving the field of TMJ research forward. Over the past 12 years, in vivo approaches for tissue engineering have emerged, along with a wide variety of degeneration models, as well as with models occurring in nature. Furthermore, biomechanical tools have become more sensitive and new biologic interventions for disease are being developed. Clinical directives have evolved for specific diagnoses, along with patient-specific biological and immunological responses to TMJ replacement devices alloplastic and/or bioengineered devices. The sixth TMJBC heralded many opportunities for funding agencies to advance the field: (1) initiatives on TMJ that go beyond pain research, (2) more training grants focused on graduate students and fellows, (3) partnership funding with government agencies to translate TMJ solutions, and (4) the recruitment of a critical mass of TMJ experts to participate on grant review panels. The TMJ research community continues to grow and has become a pillar of dental and craniofacial research, and together we share the unified vision to ultimately improve diagnoses and treatment outcomes in patients affected by TMJ disorders.
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Affiliation(s)
- Alejandro J Almarza
- Departments of Oral Biology and Bioengineering, Center for Craniofacial Regeneration, McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Louis G Mercuri
- Visiting Professor Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612; TMJ Concepts, Ventura, CA 93003
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616
| | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich CH-8031, Switzerland
| | - Eric Granquist
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | - Sunil Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143
| | - Michael S Detamore
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, OK 73019
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10
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Wu Y, Cisewski SE, Coombs MC, Brown MH, Wei F, She X, Kern MJ, Gonzalez YM, Gallo LM, Colombo V, Iwasaki LR, Nickel JC, Yao H. Effect of Sustained Joint Loading on TMJ Disc Nutrient Environment. J Dent Res 2019; 98:888-895. [PMID: 31126205 DOI: 10.1177/0022034519851044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The temporomandibular joint (TMJ) disc nutrient environment profoundly affects cell energy metabolism, proliferation, and biosynthesis. Due to technical challenges of in vivo measurements, the human TMJ disc extracellular nutrient environment under load, which depends on metabolic rates, solute diffusion, and disc morphometry, remains unknown. Therefore, the study objective was to predict the TMJ disc nutrient environment under loading conditions using combined experimental and computational modeling approaches. Specifically, glucose consumption and lactate production rates of porcine TMJ discs were measured under varying tissue culture conditions (n = 40 discs), and mechanical strain-dependent glucose and lactate diffusivities were measured using a custom diffusion chamber (n = 6 discs). TMJ anatomy and loading area were obtained from magnetic resonance imaging of healthy human volunteers (n = 11, male, 30 ± 9 y). Using experimentally determined nutrient metabolic rates, solute diffusivities, TMJ anatomy, and loading areas, subject-specific finite element (FE) models were developed to predict the 3-dimensional nutrient profiles in unloaded and loaded TMJ discs (unloaded, 0% strain, 20% strain). From the FE models, glucose, lactate, and oxygen concentration ranges for unloaded healthy human TMJ discs were 0.6 to 4.0 mM, 0.9 to 5.0 mM, and 0% to 6%, respectively, with steep gradients in the anterior and posterior bands. Sustained mechanical loading significantly reduced nutrient levels (P < 0.001), with a critical zone in which cells may die representing approximately 13.5% of the total disc volume. In conclusion, this study experimentally determined TMJ disc metabolic rates, solute diffusivities, and disc morphometry, and through subject-specific FE modeling, revealed critical interactions between mechanical loading and nutrient supply and metabolism for the in vivo human TMJ disc. The results suggest that TMJ disc homeostasis may be vulnerable to pathological loading (e.g., clenching, bruxism), which impedes nutrient supply. Given difficulties associated with direct in vivo measurements, this study provides a new approach to systematically investigate homeostatic and degenerative mechanisms associated with the TMJ disc.
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Affiliation(s)
- Y Wu
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,2 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - S E Cisewski
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - M C Coombs
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - M H Brown
- 3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - F Wei
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - X She
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - M J Kern
- 3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - Y M Gonzalez
- 4 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - L M Gallo
- 5 Clinic of Masticatory Disorders, University of Zurich, School of Dental Medicine, Zurich, Switzerland
| | - V Colombo
- 5 Clinic of Masticatory Disorders, University of Zurich, School of Dental Medicine, Zurich, Switzerland
| | - L R Iwasaki
- 6 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - J C Nickel
- 6 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - H Yao
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,2 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA.,3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
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11
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Iwasaki LR, Gallo LM, Markova M, Erni S, Liu H, Nickel JC. Night‐time autonomic nervous system ultradian cycling and masticatory muscle activity. Orthod Craniofac Res 2019; 22 Suppl 1:107-112. [DOI: 10.1111/ocr.12267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Laura R. Iwasaki
- Department of OrthodonticsSchool of DentistryOregon Health & Science University Portland Oregon
| | - Luigi M. Gallo
- Department of Masticatory DisordersSchool of DentistryUniversity of Zurich Zurich Switzerland
| | - Michala Markova
- Department of Masticatory DisordersSchool of DentistryUniversity of Zurich Zurich Switzerland
| | - Stefan Erni
- Department of Masticatory DisordersSchool of DentistryUniversity of Zurich Zurich Switzerland
| | - Hongzeng Liu
- Department of OrthodonticsSchool of DentistryOregon Health & Science University Portland Oregon
| | - Jeff C. Nickel
- Department of OrthodonticsSchool of DentistryOregon Health & Science University Portland Oregon
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12
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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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Gallo LM, Fankhauser N, Gonzalez YM, Liu H, Liu Y, Nickel JC, Iwasaki LR. Jaw closing movement and sex differences in temporomandibular joint energy densities. J Oral Rehabil 2018; 45:97-103. [PMID: 29164651 PMCID: PMC5799013 DOI: 10.1111/joor.12588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 01/22/2023]
Abstract
Energy densities (ED, mJ/mm3 ) quantify mechanical work imposed on articular cartilages during function. This cross-sectional study examined differences in temporomandibular joint (TMJ) ED during asymmetric versus symmetric jaw closing in healthy females versus males. ED component variables were tested for differences between and within sexes for two types of jaw closing. Seventeen female and 17 male subjects gave informed consent to participate. Diagnostic criteria for temporomandibular disorders and images (magnetic resonance (MR), computed tomography) were used to confirm healthy TMJ status. Numerical modelling predicted TMJ loads (Fnormal ) consequent to unilateral canine biting. Dynamic stereometry combined MR imaging and jaw-tracking data to measure ED component variables during 10 trials of each type of jaw closing in each subject's TMJs. These data were then used to calculate TMJ ED during jaw closing asymmetrically and symmetrically. Paired and Student's t tests assessed ED between jaw closing movements and sexes, respectively. Multivariate data analyses assessed ED component variable differences between jaw closing movements and sexes (α = 0.05). Contralateral TMJ ED were 3.6-fold and significantly larger (P < .0001) during asymmetric versus symmetric jaw closing, due to significantly larger (P ≤ .001) distances of TMJ stress-field translation in asymmetric versus symmetric movement. During asymmetric jaw closing, contralateral TMJ ED were twofold and significantly larger (P = .036) in females versus males, due to 1.5-fold and significantly smaller (P ≤ .010) TMJ disc cartilage volumes under stress fields in females versus males. These results suggest that in healthy individuals, asymmetric compared to symmetric jaw closure in females compared to males has higher TMJ mechanical fatigue liabilities.
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Affiliation(s)
- L M Gallo
- Department of Masticatory Disorders, School of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - N Fankhauser
- Department of Masticatory Disorders, School of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Y M Gonzalez
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - H Liu
- Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Y Liu
- Department of Biostatistics & Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - J C Nickel
- Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - L R Iwasaki
- Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
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