Static and dynamic loading effects on temporomandibular joint disc tractional forces

Changes of the condylar cartilage and subchondral bone in the temporomandibular joints of rats under unilateral mastication and expression of Insulin-like Growth Factor-1

OBJECTIVES

This study aimed to define changes in the rat condylar cartilage and subchondral bone using the unilateral mastication model.

MATERIALS AND METHODS

In this study, forty 4-week-old Wistar rats were randomly divided into experimental (n = 20) and control group (n = 20). In the experimental group, unilateral dental splints were placed on the occlusal surface of left maxillary molars. The rats were sacrificed at 1, 2, 3, and 4 weeks after placement of the splint. Micro-CT scanning and histological staining were performed to observe the changes in the mandibular condylar cartilage and subchondral bone. Levels of insulin-like growth factor-1 (IGF-1) were determined via immunohistochemistry to analyse the occurrence of osteogenic changes.

RESULTS

Micro-CT scanning findings demonstrated the occurrence of asymmetric growth of condyle in the experimental group. The condylar cartilage and subchondral bone exhibited degradation on the chewing side of the experimental group and showed decreased bone mineral density, thinner cartilage thickness, and increased degree of degeneration and osteoclast activity. Compared with the control group, the expression of IGF-1 was remarkably higher on the non-chewing side.

CONCLUSION

Long-term unilateral mastication can lead to the occurrence of degenerative changes in the condylar cartilage and subchondral bone during growth and development. IGF-1 may play a role in promoting the process of osteogenesis.

Fluid pressurization and tractional forces during TMJ disc loading: A biphasic finite element analysis

OBJECTIVES

To investigate the ploughing mechanism associated with tractional force formation on the temporomandibular joint (TMJ) disc surface.

SETTING AND SAMPLE POPULATION

Ten left TMJ discs were harvested from 6- to 8-month-old male Yorkshire pigs.

MATERIALS AND METHODS

Confined compression tests characterized mechanical TMJ disc properties, which were incorporated into a biphasic finite element model (FEM). The FEM was established to investigate load carriage within the extracellular matrix (ECM) and the ploughing mechanism during tractional force formation by simulating previous in vitro plough experiments.

RESULTS

Biphasic mechanical properties were determined in five TMJ disc regions (average±standard deviation for aggregate modulus: 0.077±0.040 MPa; hydraulic permeability: 0.88±0.37×10^-3 mm⁴ /Ns). FE simulation results demonstrated that interstitial fluid pressurization is a dominant loading support mechanism in the TMJ disc. Increased contact load and duration led to increased solid ECM strain and stress within, and increased ploughing force on the surface of the disc.

CONCLUSION

Sustained mechanical loading may play a role in load carriage within the ECM and ploughing force formation during stress-field translation at the condyle-disc interface. This study further elucidated the mechanism of ploughing on tractional force formation and provided a baseline for future analysis of TMJ mechanics, cartilage fatigue and early TMJ degeneration.

Evaluation of C-Reactive Protein Level in Patients with Pain Form of Temporomandibular Joint Dysfunction

Temporomandibular joint dysfunction is a functional disorder concerned with the abnormal functioning of the muscles of the stomatognathic system and temporomandibular joints involved in the dynamic movements of the jaw and surrounding structures. The aim of the study was to compare the level of C-reactive protein in patients with pain and painless forms of temporomandibular joint dysfunction. Materials and methods. The study group consisted of 72 patients who reported to the prosthetic treatment because of temporomandibular joint dysfunction. The study group included 36 patients with pain form of dysfunction, and the control group included 36 patients with painless form of disorder. Each patient underwent specialized examination of functional disorders in order to diagnose the type of dysfunction and was commissioned to carry out a study of the blood test concerned with evaluation of the C-reactive protein (CRP) level in the same analytical laboratory. The results of the investigation were subjected to statistical analysis. The research obtained approval from the Ethics Committee of the Jagiellonian University (KBET/125/L/2013). Level of Evidence for primary research was established as type V. Results. The mean values of C-reactive protein levels in both groups were in the normal range and did not differ statistically significantly, which indicates the fact that the pain form of the temporomandibular joint disorders is not associated with inflammation of the soft tissues of the joint. Conclusion. Painful form of the temporomandibular joint dysfunctions is not connected with the inflammation of joints.

Mechanobehavioral Scores in Women with and without TMJ Disc Displacement

Cartilage fatigue may be a factor in the precocious development of degenerative changes in the temporomandibular joint (TMJ). This cross-sectional study estimated potential for cartilage fatigue via TMJ energy densities (ED) and jaw muscle duty factors (DF), which were combined to calculate mechanobehavioral scores (MBS) in women with (+) and without (-) bilateral TMJ disc displacement (DD). All subjects gave informed consent to participate and were examined using Diagnostic Criteria (DC) for Temporomandibular Disorders (TMD) and magnetic resonance (MR) and computed tomography (CT) images. Forty-seven subjects were categorized into +DD ( n = 29) and -DD ( n = 18) groups. Dynamic stereometry (MR images combined with jaw-tracking data) characterized individual-specific data of TMJ stress-field mechanics to determine ED (ED = W/ Q mJ/mm3, where W = work done, Q = volume of cartilage) during 10 symmetrical jaw-closing cycles with a 20-N mandibular right canine load. Subjects were trained to record masseter and temporalis electromyography over 3 days and 3 nights. Root mean square electromyography/bite-force calibrations determined subject-specific masseter and temporalis muscle activities per 20-N bite-force (T20 N, µV), which defined thresholds. Muscle DF (DF = % duration of muscle activity/total recording time) were determined for a range of thresholds, and MBS (ED2 × DF) were calculated. Intergroup differences in ED, DF, and MBS were assessed via analyses of variance with Bonferroni and Tukey honest significant difference post hoc tests. Average ED for contralateral TMJs was significantly larger ( P = 0.012) by 1.4-fold in +DD compared to -DD subjects. Average DF were significantly larger (all P < 0.01) for +DD compared to -DD subjects by 1.7-, 2.5-, and 1.9-fold for day, night, and overall, respectively. Daytime MBS were significantly larger (all P < 0.04) by up to 8.5-fold in +DD compared to -DD subjects. Significantly larger ED, DF, and MBS were shown in women with compared to women without bilateral TMJ DD.

Postero-inferior condylar movement induced by artificial occlusal interference on the balancing side during fictive mastication in rabbits

OBJECTIVE

Tooth contact does not occur on the balancing side during mastication. Hence, it is possible that the presence of occlusal interference on the balancing side causes mandibular rotation followed by atypical condylar movement because the jaw-closing muscle activity on the working side is greater than on the balancing side. The aim of the present study was to investigate the relationship between occlusal contact on the balancing side and condylar movement during mastication.

METHODS

EMG activity of the masseter (MS), lateral pterygoid (LP) and digastric (DG) muscles and jaw movements were recorded. Condylar movements in the sagittal plane were recorded using a high speed charge-coupled device (CCD) camera. Incisal point movements were recorded using a magnet on the mentum and a magnetometric sensor on the nasal bone. A removable biting plate was used to introduce an artificial occlusal interference on the balancing side.

RESULTS

Nine of the 10 rabbits showed large postero-inferior condylar movement (Pi-Cm) when a biting plate was applied on the balancing side. Five rabbits showed very small Pi-Cm when a biting plate was applied on the balancing side. In the small Pi-Cm group, MS activity decreased markedly and LP and DG transient activity appeared in the early occlusal phase in the presence of the biting plate.

CONCLUSION

Interference on the balancing side always caused Pi-Cm on the ipsilateral side during mastication. However, the degree of Pi-Cm was often decreased by a jaw opening reflex response.

Unusual postero-inferior condylar movements that depend on the position of occlusal contact during fictive mastication in rabbits

OBJECTIVE

The mandible can be modelled as a triangular plate supported at two joints and the point of occlusion. The mandible is stable if the vector of the jaw-closing muscle forces lies within the triangle of support. If this vector lies outside of the triangle of support, one of the three contact points will tend to separate as the mandible rotates around a line connecting the other two points. Here, we examined whether postero-inferior condylar movements (Pi-Cm) due to mandibular rotation may occur during fictive mastication in anaesthetized rabbits.

METHODS

EMG activities of the masseter (MS) and lateral pterygoid (LP) muscles and movements of the condyle and incisal points were recorded. Condylar movements in the sagittal plane were recorded using a high speed CCD camera.

RESULTS

Pi-Cm were observed on the working side during occlusal phase in half of the rabbits (altered-movement group), if the biting point was restricted at the posterior most tooth (M3) on the working side using a metal biting plate. Pi-Cm appeared in the period between the estimated maximum force of the MS and the LP during late occlusal phase. The MS EMG ratio between the working and balancing sides in the altered-movement group was significantly less than that in the unaltered-movement group.

CONCLUSION

Since the space lying between the condyle and the articular eminence expanded during the Pi-Cm, it is likely that the posterior band of the articular disc tended to slip anteriorly. The clinical significance of the Pi-Cm is discussed concerning the anterior dislocation of the disc in patients with TMJ disorder.

Role of interstitial fluid pressurization in TMJ lubrication

In temporomandibular joints (TMJs), the disc and condylar cartilage function as load-bearing, shock-absorbing, and friction-reducing materials. The ultrastructure of the TMJ disc and cartilage is different from that of hyaline cartilage in other diarthrodial joints, and little is known about their lubrication mechanisms. In this study, we performed micro-tribometry testing on the TMJ disc and condylar cartilage to obtain their region- and direction-dependent friction properties. Frictional tests with a migrating contact area were performed on 8 adult porcine TMJs at 5 different regions (anterior, posterior, central, medial, and lateral) in 2 orthogonal directions (anterior-posterior and medial-lateral). Some significant regional differences were detected, and the lateral-medial direction showed higher friction than the anterior-posterior direction on both tissues. The mean friction coefficient of condylar cartilage against steel was 0.027, but the disc, at 0.074, displayed a significantly higher friction coefficient. The 2 tissues also exhibited different frictional dependencies on sliding speed and normal loading force. Whereas the friction of condylar cartilage decreased with increased sliding speed and was independent of the magnitude of normal force, friction of the disc showed no dependence on sliding speed but decreased as normal force increased. Further analysis of the Péclet number and frictional coefficients suggested that condylar cartilage relies on interstitial fluid pressurization to a greater extent than the corresponding contact area of the TMJ disc.

A new measure of tibiofemoral subchondral bone interactions that correlates with early cartilage damage in injured sheep

We have demonstrated previously that chondral damage is associated with increased knee surface velocities following ligament and meniscus injuries in sheep. We tested the hypothesis that cartilage damage scores would correlate with a new bone surface interaction measure that captures complex changes in tibiofemoral alignment, "proximity disturbance" (PD). Six sheep underwent combined anterior cruciate and medial collateral ligament transection (ACL/MCLx), five complete lateral meniscectomy (Mx), and four sham arthrotomy (Sham). Tibiofemoral subchondral bone surfaces were modeled, and the post-operative changes in relative separation of the surfaces (i.e., "proximity") were derived from subject-specific in vivo 3D stifle kinematics. Surface areas of regions of near contact were determined, and PD was calculated as the range of change in tibiofemoral proximity, divided by normalized overlapping proximity surface areas between baseline and post-operative time points. Cartilage morphology was graded at dissection. ACL/MCLx PD was significantly elevated relative to Mx and Shams, and correlated with cartilage damage (r(2)  = 0.88-0.98). Although not statistically significant, Mx PD values tended to be higher than those of Shams, and correlated with cartilage damage. Results from both injury models suggest that increasing change in tibiofemoral surface alignment may be increasingly deleterious to long-term cartilage health in sheep.

Altered tibiofemoral joint contact mechanics and kinematics in patients with knee osteoarthritis and episodic complaints of joint instability

BACKGROUND

To evaluate knee joint contact mechanics and kinematics during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability.

METHODS

Forty-three subjects, 11 with medial compartment knee osteoarthritis and self-reported instability (unstable), 7 with medial compartment knee osteoarthritis but no reports of instability (stable), and 25 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a downhill gait task on a treadmill.

FINDINGS

The medial compartment contact point excursions were longer in the unstable group compared to the stable (P=0.046) and the control groups (P=0.016). The peak medial compartment contact point velocity was also greater for the unstable group compared to the stable (P=0.047) and control groups (P=0.022). Additionally, the unstable group demonstrated a coupled movement pattern of knee extension and external rotation after heel contact which was different than the coupled motion of knee flexion and internal rotation demonstrated by stable and control groups.

INTERPRETATION

Our findings suggest that knee joint contact mechanics and kinematics are altered during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability. The observed longer medial compartment contact point excursions and higher velocities represent objective signs of mechanical instability that may place the arthritic knee joint at increased risk for disease progression. Further research is indicated to explore the clinical relevance of altered contact mechanics and kinematics during other common daily activities and to assess the efficacy of rehabilitation programs to improve altered joint biomechanics in knee osteoarthritis patients with self-reported instability.

Tibiofemoral centroid velocity correlates more consistently with cartilage damage than does contact path length in two ovine models of stifle injury

Anterior cruciate ligament (ACL) rupture and/or meniscal injury are known risk factors for post-traumatic osteoarthritis. We tested the hypothesis that increasingly abnormal tibiofemoral centroid path lengths and velocities would correlate with the severity of cartilage damage in injured sheep. Six sheep underwent combined ACL/medial collateral ligament transection (ACL/MCLx), five complete lateral meniscectomy (Mx), and four sham arthrotomy (Sham). Weighted centroids were used to estimate in vivo tibiofemoral cartilage contact path length during stance and the velocity of relative motion. Cartilage morphology was graded at dissection. Ligament transection significantly elongated plateau centroid path lengths and velocities, whereas condyle paths and velocities were reduced. Differences between plateau and femoral velocities (relative centroid velocity) were increased up to 10-fold over baseline values in the medial compartment. Reductions in Mx lateral compartment paths were significantly different from ACL/MCLx paths, but not relative to baseline or Sham values. Importantly, only centroid velocities consistently correlated with cartilage damage in either injury model, suggesting that while path length is valuable in detecting changes in the envelope of joint motion, it may average out meaningful peaks in the rate of relative motion that more closely relate to the mechanisms that might be damaging articular cartilage in these models.

Establishing better biological models to understand occlusion. I: TM joint anatomic relationships

Belief in and rejection of a relationship of occlusion and temporomandibular joint (TMJ) condyle-fossa position with normal and abnormal function are still contentious issues. Clinical opinions can be strong, but support in most published data (mostly univariate) is problematic. Distribution overlap, low sensitivity and specificity are a common basis to reject any useful prediction value. Notwithstanding, a relationship of form with function is a basic tenet of biology. These are multifactor problems, but the questions mostly have not been analysed as such. This review moves the question forward by focusing on TM joint anatomic organisation as the multifactor system it is expected to be in a closed system like a synovial joint. Multifactor analysis allows the data to speak for itself and reduces bias. Classification tree analysis revealed useful prediction values and usable clinical models which are illustrated, backed up by stepwise logistic regression. Explained variance, R(2), predicting normals from pooled TMJ patients was 32·6%, sensitivity 67·9%, specificity 85·7%; 37% versus disc displacement with reduction; and 28·8% versus disc displacement without reduction. Significant osseous organisational differences between TM joints with clicking and locking suggest that this is not necessarily a single disease continuum. However, a subset of joints with clicking contained characteristics of joints with locking that might contribute to symptom progression versus resistance. Moderately strong models confirm there is a relationship between TMJ osseous organisation and function, but it should not be overstated. More than one model of normals and of TM derangement organisation is revealed. The implications to clinical decision-making are discussed.

Cone beam computed tomography: craniofacial and airway analysis

Imaging plays a role in the anatomic assessment of the airway and adjacent structures. This article discusses the use of 3-dimensional (3D) imaging (cone beam computed tomography [CBCT]) to evaluate the airway and selected regional anatomic variables that may contribute to obstructive sleep-disordered breathing (OSDB) in patients. CBCT technology uses a cone-shaped x-ray beam with a special image intensifier and a solid-state sensor or an amorphous silicon plate for capturing the image. Incorporation of 3D imaging into daily practice will allow practitioners to readily evaluate and screen patients for phenotypes associated with OSDB.

Design, construction and validation of a computer controlled system for functional loading of soft tissue

Osteoarthritis is a chronic degenerative disease affecting body joints. Abnormal mechanical loading could be an initiating factor of cartilage damage, by influencing chondrocytes activity. To date, devices performing mechanical studies of viable tissues are mostly uniaxial. In this work, we developed and validated a multi-axial device for static and dynamic mechanical testing of viable soft tissues. The system, named RPETS, is composed of a motor driven indenter, moving vertically and horizontally along the bottom of a tank containing tissue samples and it can apply combined compression, sliding, and rolling on viable samples. Validation studies were performed with standard rubber and bovine nasal cartilage tissue. Static tests demonstrated that the system is comparable to existing uniaxial devices, with a maximum force control error smaller than 0.5N and a positioning resolution of 5 μm. Dynamic tests performed with different motion profiles showed that the system can exert a load of 100N with a maximum velocity of 100mm/s maintaining the force control error within 10% of the desired value. Sinusoidal motion frequency can vary between 0.05 and 0.5Hz. In practical tests, viability staining of dynamically loaded cartilage slices showed extents of cell death to depend on the indenter velocity.

Temporomandibular joint loads in subjects with and without disc displacement

The likelihood of development of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) is related to the integrity of the TMJ disc. Predilection for mechanical failure of the TMJ disc may reflect inter-individual differences in TMJ loads. Nine females and eight males in each of normal TMJ disc position and bilateral disc displacement diagnostic groups consented to participate in our study. Disc position was determined by bilateral magnetic resonance images of the joints. Three-dimensional (3D) anatomical geometry of each subject was used in a validated computer-assisted numerical model to calculate ipsilateral and contralateral TMJ loads for a range of biting positions (incisor, canine, molar) and angles (1-13). Each TMJ load was a resultant vector at the anterosuperi or-most mediolateral midpoint the condyle and characterized in terms of magnitude and 3D orientation. Analysis of variance (ANOVA) was used to test for effects of biting position and angle on TMJ loads. Mean TMJ loads in subjects with disc displacement were 9.5-69% higher than in subjects with normal disc position. During canine biting, TMJ loads in subjects with disc displacement were 43% (ipsilateral condyle, p=0.029) and 49% (contralateral condyle, p=0.015) higher on average than in subjects with normal disc position. Biting angle effects showed that laterally directed forces on the dentition produced ipsilateral joint loads, which on average were 69% higher (p=0.002) compared to individuals with normal TMJ disc position. The data reported here describe large differences in TMJ loads between individuals with disc displacement and normal disc position. The results support future investigations of inter-individual differences in joint mechanics as a variable in the development of DJD of the TMJ.

Static and dynamic mechanics of the temporomandibular joint: plowing forces, joint load and tissue stress

OBJECTIVES - To determine the combined effects 1) of stress-field aspect ratio and velocity and compressive strain and 2) joint load, on temporomandibular joint (TMJ) disc mechanics. SETTING AND SAMPLE POPULATION - Fifty-two subjects (30 female; 22 male) participated in the TMJ load experiments. MATERIAL AND METHODS - In the absence of human tissue, pig TMJ discs were used to determine the effects of variables 1) on surface plowing forces, and to build a biphasic finite element model (bFEM) to test the effect of human joint loads and 2) on tissue stresses. In the laboratory, discs received a 7.6 N static load via an acrylic indenter before cyclic movement. Data were recorded and analysed using anova. To determine human joint loads, Research Diagnostic Criteria calibrated investigators classified subjects based on signs of disc displacement (DD) and pain (+DD/+pain, n = 18; +DD/-pain, n = 17; -DD/-pain, n = 17). Three-dimensional geometries were produced for each subject and used in a computer model to calculate joint loads. RESULTS - The combined effects of compressive strain, and aspect ratio and velocity of stress-field translation correlated with plowing forces (R(2) = 0.85). +DD/-pain subjects produced 60% higher joint loads (ANOVA, p < 0.05), which increased bFEM-calculated compressive strain and peak total normal stress. CONCLUSIONS - Static and dynamic variables of the stress-field and subject-dependent joint load significantly affect disc mechanics.

Tractional Forces on Porcine Temporomandibular Joint Discs

Tractional forces on the temporomandibular joint (TMJ) disc predispose tissue fatigue. This study tested the hypotheses that tractional forces: (1) increased with stress-field velocity ( V) and aspect ratio ( AR, contact area diameter/cartilage thickness), and compressive strain (ε); and (2) varied depending on cartilage thickness. Porcine TMJ discs (n = 187) received a 10-N vertical static load via an acrylic indenter for 1, 5, 10, 30, or 60 sec, followed by movement. Physical data were recorded and analyzed by quadratic regression relations and a likelihood ratio test. Results showed non-linear increases in tractional forces that were positively correlated with increased V, AR, and ε when the stress-field moved onto relatively thicker (R2 = 0.83) and thinner cartilage (R2 = 0.86). When V was > 27 mm/sec and AR·ε3, was > 0.09, tractional forces were significantly higher (≤ 12% of peak) when the stress-field moved onto thicker cartilage. Stress-field dynamic mechanics and cartilage thickness significantly affected TMJ disc tractional forces.

A biphasic finite element model of in vitro plowing tests of the temporomandibular joint disc

Disorders of the temporomandibular joint (TMJ) afflict 3-29% of people aged 19-40 years. Degenerative joint disease (DJD) of the TMJ generally occurs 15 years earlier than in other human joints and 1.5-2 times more often in women than men. The TMJ disc is the primary stress distribution mechanism within the joint. Mechanical failure of the TMJ disc precedes clinical signs of DJD. Unlike postcranial synovial joints, biomimetic replacements of the disc have not been successful, probably due to the paucity of knowledge about TMJ biomechanics. Translation of stress-fields mediolaterally across the TMJ disc may lead to fatigue failure because of the effect of traction forces on the tissue surface and because the disc is relatively weak in this aspect. Traction forces are composed of friction forces, which are known to be low in the TMJ, and plowing forces which are relatively much higher and result from movement and pressurization of fluids within the tissues due to translating surface loads. In the in vitro plowing experiment, a rigid curve-ended indenter is lowered into a TMJ disc that has been mounted on a stage with pressure gauges, and the indenter is then translated in a prescribed mediolateral motion that is intended to simulate the motion of the mandibular condyle on the TMJ disc in vivo. As a first step, these plowing experiments have quantified the variables thought to be important in tissue failure. A next step is to define the full role of these variables in the pathomechanics of TMJ disc tissue through a validated model. Therefore, the aim of this study was to develop and test a finite element model of the plowing experiments based on an orthotropic biphasic description of the soft tissue behavior of the TMJ disc. For this plowing model, the arbitrary Lagrange Eulerian method was used to approximate the moving load problem, where in vitro the indenter slid along the tissue's superior surface. Approximate validation of the plowing model was based on comparisons of model-predicted temporal and spatial distribution of indenter displacement and total normal stresses (+/-15%) and laboratory measurements during one complete cycle of plowing motion. Other useful predictions from the plowing model include spatial and temporal distributions of biomechanical variables of interest that cannot be measured experimentally, such as total stress, pressure, strain, and the relative significance of the orthotropic solid phase properties.

The association between velocity of the center of closest proximity on subchondral bones and osteoarthritis progression

Altered surface interactions following joint instability may apply novel, damaging loads to articular cartilage. This study measured the velocity of the centers of closest proximity on subchondral bone surfaces on the femur and tibia during running in normal and unstable canine stifle (knee) joints. The purpose was to explore the relationship between the velocity of the centers of closest proximity on subchondral bones and the severity of cartilage damage. Dynamic biplane radiography was used to acquire serial knee kinematics [5 control, 18 cranial cruciate ligament (CCL) deficient] during treadmill running over 2 years. Custom software calculated the difference between the rate at which the center of closest proximity on the femur translated relative to the femur bone surface and the rate at which the center of closest proximity on the tibia translated relative to the tibia bone surface. Comparisons were made between dogs that developed minor versus major medial compartment cartilage damage over 2 years. Major damage dogs showed a significantly greater increase in the difference between femur and tibia medial compartment closest proximity point velocity from the instant of paw strike to peak velocity difference at 2, 4, and 6 months after CCL transaction. This implies increased tangential forces associated with the velocity of the compressed cartilage region during joint movement (plowing) may be a mechanism that initiates osteoarthritis (OA) development and drives OA progression. In the future, articulating surface velocity measurements may be useful to identify patients at risk for long-term OA due to joint instability.

Degenerative Disorders of the Temporomandibular Joint: Etiology, Diagnosis, and Treatment

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.

Effects of masticatory muscle force on temporomandibular joint disc growth in rats

Biomechanical factors in masticatory function are related to the development of the mandible and the condyle. Previous studies have reported that reduced masticatory muscle force influences mandibular bone formation and chondroblastic proliferation. We examined the importance of compressive force in temporomandibular joint (TMJ) disc growth by reducing the masticatory load. Thirty 3-week-old male Wistar rats were used in this study. In the experimental group, the masseter muscles were bilaterally resected to evaluate the influence of masticatory muscle force on morphology and composition of TMJ disc during growth. No surgery was performed in the control group. The thickness of the TMJ disc was measured to evaluate the morphological changes. The localization of type I collagen and decorin was performed by immunostaining to examine compositional change. Cell proliferation in the disc was identified by insulin-like growth factor-1 receptor (IGF-1r) immunostaining. The disc thickness at each region in the experimental group was reduced compared to the control group. While in the control group, type I collagen and decorin were identified throughout the disc, it was concentrated on the superior portion of the disc at the anterior and posterior bands in the experimental group. The expression of IGF-1r immunopositive cells in the experimental group was also significantly lower than in the control. We conclude that masticatory muscle force is closely related to TMJ disc morphology and composition during growth.