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Bi R, Jiang N, Yin Q, Chen H, Liu J, Zhu S. A new clinical classification and treatment strategies for temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2020; 49:1449-1458. [PMID: 32247547 DOI: 10.1016/j.ijom.2020.02.020] [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: 07/05/2019] [Revised: 12/21/2019] [Accepted: 02/10/2020] [Indexed: 02/08/2023]
Abstract
Temporomandibular joint ankylosis (TMJA) is a complicated condition that affects not only the condyle, but also the maxillofacial complex. Thus, it is often challenging to find a standardized treatment strategy for TMJA. This study was performed to analyse our experience with 95 TMJA patients over a 4-year period and develop a new classification system ('CDA'). The CDA classification system divides TMJA patients into eight different groups according to the preservability of the condyle (C), severity of the dentofacial bone deformity (D), and skeletal age (A). The 95 patients (129 ankylosed joints) were treated using different strategies based on this CDA classification. Treatment options included preserving or reconstructing the condylar head, surgical correction of jaw deformities, and close follow-up of mandibular growth. After treatment, all 129 ankylosed joints were completely released and the average maximum inter-incisal opening (MIO) increased from 3.6 ± 3.2 mm to 32.8 ± 5.4 mm, with no recurrence of ankylosis found during follow-up. In conclusion, this new CDA classification can effectively guide treatment strategies for TMJA patients. Using particular strategies for patients based on specific CDA classifications could provide optimal management to the benefit of TMJA patients.
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Affiliation(s)
- R Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - N Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Q Yin
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - H Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - S Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Zhang X, Yi J, Li Y. Effects of nutrition and hormones on functional appliance treatment outcome in patients with skeletal Class II malocclusion. J World Fed Orthod 2020; 9:9-12. [PMID: 32672667 DOI: 10.1016/j.ejwf.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional appliances has been used for treatment of skeletal Class II malocclusion for a long time; however, the real skeletal effects, mandibular growth particularly, remain insufficient. Several auxiliary approaches have been attempted with the hope of enhancing treatment effects. In this review, we summarize and discuss the use of additional nutrition and hormones to assist the functional appliance treatment on patients with skeletal Class II malocclusion. METHODS Relevant articles were identified by electronic research in MEDLINE Ovid using keywords such as "nutrition," "hormone," "functional appliance," "orthodontics," "maxillofacial development," and "maxillofacial abnormalities." References of related articles were assessed for relevant studies to identify additional published references. RESULTS The literature search yielded 239 studies. According to the current literature, use of additional nutrition and hormones, including growth hormones, sex hormones, insulin, and insulin-like growth factor I, seem to improve the effects of functional appliance treatment on patients with skeletal Class II malocclusion. CONCLUSIONS The current evidence indicates that additional nutrition or hormones might improve the treatment effects on mandibular hypoplasia compared with the functional appliance alone, which is a promising approach and calls for further studies.
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Affiliation(s)
- Xu Zhang
- Postgraduate Student, State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jianru Yi
- Lecturer, State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yu Li
- Professor, State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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53
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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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54
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Wang W, Qin L, Yuan X, Ming X, Sun T, Liu Y. Bionic control of exoskeleton robot based on motion intention for rehabilitation training. Adv Robot 2019. [DOI: 10.1080/01691864.2019.1621774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Wendong Wang
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi’an, People’s Republic of China
| | - Lei Qin
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi’an, People’s Republic of China
| | - Xiaoqing Yuan
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi’an, People’s Republic of China
| | - Xing Ming
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi’an, People’s Republic of China
| | - Tongsen Sun
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi’an, People’s Republic of China
| | - Yifan Liu
- School of Mechanical Engineering, Northwestern Polytechnical University, Xi’an, People’s Republic of China
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55
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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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56
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Mehta NR. The neck-jaw interaction revisited. Cranio 2019; 37:4. [PMID: 31033421 DOI: 10.1080/08869634.2019.1546646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Noshir R Mehta
- a Department of Public Health and Community Service , Tufts University School of Dental Medicine , Boston , MA , USA
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57
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Coombs MC, She X, Brown TR, Slate EH, Lee JS, Yao H. Temporomandibular Joint Condyle-Disc Morphometric Sexual Dimorphisms Independent of Skull Scaling. J Oral Maxillofac Surg 2019; 77:2245-2257. [PMID: 31125537 DOI: 10.1016/j.joms.2019.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Approximately 2 to 4% of the US population have been estimated to seek treatment for temporomandibular symptoms, predominately women. The study purpose was to determine whether sex-specific differences in temporomandibular morphometry result from scaling with sex differences in skull size and shape or intrinsic sex-specific differences. MATERIALS AND METHODS A total of 22 (11 male [aged 74.5 ± 9.1 years]; 11 female [aged 73.6 ± 12.8 years]) human cadaveric heads with no history of temporomandibular disc derangement underwent cone beam computed tomography and high-resolution magnetic resonance imaging scanning to determine 3-dimensional cephalometric parameters and temporomandibular morphometric outcomes. Regression models between morphometric outcomes and cephalometric parameters were developed, and intrinsic sex-specific differences in temporomandibular morphometry normalized by cephalometric parameters were determined. Subject-specific finite element (FE) models of the extreme male and extreme female conditions were developed to predict variations in articular disc stress-strain under the same joint loading. RESULTS In some cases, sex differences in temporomandibular morphometric parameters could be explained by linear scaling with skull size and shape; however, scaling alone could not fully account for some differences between sexes, indicating intrinsic sex-specific differences. The intrinsic sex-specific differences in temporomandibular morphometry included an increased condylar medial length and mediolateral disc lengths in men and a longer anteroposterior disc length in women. Considering the extreme male and female temporomandibular morphometry observed in the present study, subject-specific FE models resulted in sex differences, with the extreme male joint having a broadly distributed stress field and peak stress of 5.28 MPa. The extreme female joint had a concentrated stress field and peak stress of 7.37 MPa. CONCLUSIONS Intrinsic sex-specific differences independent of scaling with donor skull size were identified in temporomandibular morphometry. Understanding intrinsic sex-specific morphometric differences is critical to determining the temporomandibular biomechanics given the effect of anatomy on joint contact mechanics and stress-strain distributions and requires further study as one potential factor for the increased predisposition of women to temporomandibular disc derangement.
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Affiliation(s)
- Matthew C Coombs
- Postdoctoral Fellow, Department of Bioengineering, Clemson University, Clemson, SC; and Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Xin She
- Graduate Assistant, Department of Bioengineering, Clemson University, Clemson, SC
| | - Truman R Brown
- Professor, Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC
| | - Elizabeth H Slate
- Professor, Department of Statistics, Florida State University, Tallahassee, FL
| | - Janice S Lee
- Clinical Director, National Institutes of Health National Institute of Dental and Craniofacial Research, Bethesda, MD
| | - Hai Yao
- Professor, Department of Bioengineering, Clemson University, Clemson, SC; and Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC.
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58
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She X, Wei F, Damon BJ, Coombs MC, Lee DG, Lecholop MK, Bacro TH, Steed MB, Zheng N, Chen X, Yao H. Three-dimensional temporomandibular joint muscle attachment morphometry and its impacts on musculoskeletal modeling. J Biomech 2018; 79:119-128. [PMID: 30166225 DOI: 10.1016/j.jbiomech.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/26/2018] [Accepted: 08/10/2018] [Indexed: 01/03/2023]
Abstract
In musculoskeletal models of the human temporomandibular joint (TMJ), muscles are typically represented by force vectors that connect approximate muscle origin and insertion centroids (centroid-to-centroid force vectors). This simplification assumes equivalent moment arms and muscle lengths for all fibers within a muscle even with complex geometry and may result in inaccurate estimations of muscle force and joint loading. The objectives of this study were to quantify the three-dimensional (3D) human TMJ muscle attachment morphometry and examine its impact on TMJ mechanics. 3D muscle attachment surfaces of temporalis, masseter, lateral pterygoid, and medial pterygoid muscles of human cadaveric heads were generated by co-registering measured attachment boundaries with underlying skull models created from cone-beam computerized tomography (CBCT) images. A bounding box technique was used to quantify 3D muscle attachment size, shape, location, and orientation. Musculoskeletal models of the mandible were then developed and validated to assess the impact of 3D muscle attachment morphometry on joint loading during jaw maximal open-close. The 3D morphometry revealed that muscle lengths and moment arms of temporalis and masseter muscles varied substantially among muscle fibers. The values calculated from the centroid-to-centroid model were significantly different from those calculated using the 'Distributed model', which considered crucial 3D muscle attachment morphometry. Consequently, joint loading was underestimated by more than 50% in the centroid-to-centroid model. Therefore, it is necessary to consider 3D muscle attachment morphometry, especially for muscles with broad attachments, in TMJ musculoskeletal models to precisely quantify the joint mechanical environment critical for understanding TMJ function and mechanobiology.
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Affiliation(s)
- Xin She
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Feng Wei
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Brooke J Damon
- Department of Bioengineering, Clemson University, Clemson, SC, USA; Department of Oral Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Matthew C Coombs
- Department of Bioengineering, Clemson University, Clemson, SC, USA; Department of Oral Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Daniel G Lee
- Department of Oral and Maxillofacial Surgery, MUSC, Charleston, SC, USA
| | | | - Thierry H Bacro
- Center for Anatomical Studies and Education, MUSC, Charleston, SC, USA
| | - Martin B Steed
- Department of Oral and Maxillofacial Surgery, MUSC, Charleston, SC, USA
| | - Naiquan Zheng
- Department of Mechanical Engineering and Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Xiaojing Chen
- Xiangya School of Stomatology, Central South University, Changsha, China
| | - Hai Yao
- Department of Bioengineering, Clemson University, Clemson, SC, USA; Department of Oral Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA.
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