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Li C, Chen B, Zhang R, Zhang Q. Comparative study of clinical and MRI features of TMD patients with or without joint effusion: a retrospective study. BMC Oral Health 2024; 24:314. [PMID: 38461246 PMCID: PMC10924403 DOI: 10.1186/s12903-024-04065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/22/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND The relationship between joint effusion and temporomandibular disorders (TMD) remains unclear. The purpose of this study was to investigate the correlation among joint effusion, clinical features and MRI imaging features of TMD. METHODS A total of 1532 temporomandibular joints (TMJs) from 766 patients (605 females and 161 males) with the mean age of 31.68 ± 13.71 years from January 2022 to June 2023 were included in the study. Clinical and MRI features were collected and analyzed. Chi-Square test, Spearman correlation coefficient and binary logistic regression analysis were performed. RESULTS Patients with joint effusion were significantly older and had smaller value of MIO (p < 0.001). There were significant differences in the distribution of joint sounds (with or without), joint pain (with or without), disc morphology (biconcave, contracture, irregular and lengthened) and disc position between joint effusion group (JE) and non-joint effusion group (NA) (P < 0.05).The odds of having joint effusion were 1.726 higher in patients with joint sounds when compared to those without joint sounds. The odds of having joint effusion were 8.463 higher in patients with joint pain when compared to those without joint pain. The odds of having joint effusion were 2.277 higher in patients with contracture when compared to those with biconcave. The odds of having joint effusion were 1.740 higher in patients with anterior disc displacement with reduction (ADDWR) when compared to those with normal disc position. The prediction accuracy of this model is 74.9%, and the area under curve (AUC) is 79.5%, indicating that it can be used for the prediction and the judgment effect is average. CONCLUSIONS The results demonstrated that joint sounds, joint pain, contracture, and ADDWR are high risk factors for joint effusion, especially joint pain. TRIAL REGISTRATION This study was retrospectively registered on 28/03/2022 and endorsed by the Ethics Committee of Affiliated Stomatology Hospital of Guangzhou Medical University (LCYJ2022014).
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Affiliation(s)
- Chuanjie Li
- Department of Temporomandibular Joint Surgery, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Benyi Chen
- School of Stomatology, Guangzhou Medical University, Guangzhou, China
| | - Rong Zhang
- Department of Temporomandibular Joint Surgery, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, 510000, China.
| | - Qingbin Zhang
- Department of Temporomandibular Joint Surgery, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, 510000, China.
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Ulmner M, Sugars R, Naimi-Akbar A, Alstergren P, Lund B. Cytokines in temporomandibular joint synovial fluid and tissue in relation to inflammation. J Oral Rehabil 2022; 49:599-607. [PMID: 35342975 PMCID: PMC9325465 DOI: 10.1111/joor.13321] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/12/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Synovial tissue is known to be the origin of inflammation in joint disease. Despite this, synovial fluid is the main biological specimen of choice in temporomandibular joint (TMJ) inflammation and pathology biomarker research. No comparison of TMJ protein content between synovial fluid and synovial tissue has been made. OBJECTIVES To investigate if cytokine concentrations in synovial fluid can be related to cytokine concentrations in synovial tissue, and to analyse correlation of clinical parameters reflecting local inflammation to cytokine concentrations. METHODS Synovial tissue and fluid samples were obtained during the same surgical procedure from a cohort of 101 patients with TMJ disorders. Interleukin (IL) 1β, IL-6, IL-8, IL-10, and tumor necrosis factor α (TNF-α) were analysed in the samples and an intraindividual correlation made. Various patient-specific factors relating to TMJ inflammation were associated to the cytokine concentrations in synovial fluid and tissue. RESULTS No correlation between cytokine concentration in synovial fluid and synovial tissue was found, except for IL-8 (ρ=.284, P=.024). Synovial tissue cytokines correlated strongly to inflammation-related factors: diagnosis (IL-1β, P=.001; TNF-α, P=.000; IL-10, P=.000), TMJ palpation pain (IL-1β, P=.024; TNF-α, P=.025), synovitis score (IL-1β, P=.015), and subjective TMJ pain (TNF-α, P=.016). Synovial fluid cytokines showed no significant relations to inflammation. CONCLUSIONS The investigated cytokine concentrations showed weak correlations between synovial fluid and synovial tissue, besides IL-8. Synovial tissue appeared to reflect inflammation to a higher extent than synovial fluid. Thus, suggesting that synovial tissue research should complement synovial fluid in future explorations of TMJ pathology and inflammation.
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Affiliation(s)
- Mattias Ulmner
- Unit of Cranio- and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rachael Sugars
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Health Technology Assessment-Odontology, Malmö University, Malmö, Sweden
| | - Per Alstergren
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,pecialised Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Bodil Lund
- Unit of Cranio- and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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Tan J, Labrinidis A, Williams R, Mian M, Anderson PJ, Ranjitkar S. Micro-CT-Based Bone Microarchitecture Analysis of the Murine Skull. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2022; 2403:129-145. [PMID: 34913121 DOI: 10.1007/978-1-0716-1847-9_10] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
X-ray micro-computed tomography (micro-CT) imaging has important applications in microarchitecture analysis of cortical and trabecular bone structure. While standardized protocols exist for micro-CT-based microarchitecture assessment of long bones, specific protocols need to be developed for different types of skull bones taking into account differences in embryogenesis, organization, development, and growth compared to the rest of the body. This chapter describes the general principles of bone microarchitecture analysis of murine craniofacial skeleton to accommodate for morphological variations in different regions of interest.
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Affiliation(s)
- Jenny Tan
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - Agatha Labrinidis
- Adelaide Microscopy, The University of Adelaide, Adelaide, SA, Australia
| | - Ruth Williams
- Adelaide Microscopy, The University of Adelaide, Adelaide, SA, Australia
| | - Mustafa Mian
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - Peter J Anderson
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.,Australian Craniofacial Unit, Women's and Children's Hospital, North Adelaide, SA, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Sarbin Ranjitkar
- Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia. .,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.
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Frenkel B, Abu Shqara F, Rachmiel A. Proinflammatory cytokines levels in patients with temporomandibular joint disorder undergoing arthroscopy. Oral Maxillofac Surg 2021; 26:575-580. [PMID: 34716857 DOI: 10.1007/s10006-021-01014-1] [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: 01/25/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Biomarkers represent objective indicators of normal processes, pathology, or responses to therapeutic intervention. The purpose of this study is to evaluate the levels of proinflammatory cytokines in synovial fluid of the temporomandibular joint (TMJ) and to investigate whether there is a correlation between elevated levels and disease progression. MATERIALS AND METHODS This is a prospective study that included patients who were diagnosed with internal derangement according to magnetic resonance imaging and were classified according to Wilkes's classifications. After failing to improve with conservative treatment, they were referred for TMJ arthroscopy. During arthroscopy, synovial fluid was collected for biomarker analyses that included the investigation of levels of proinflammatory cytokines: tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and vascular endothelial growth factor (VEGF). The Mann-Whitney U test was used for differences between subgroups for TNF-α, IL-6, and VEGF. RESULTS During the study period, 22 patients presented with a TMJ disorder and met the criteria of the study. There was a statistically significant correlation between the levels of VEGF, TNF-a, and osteoarthritis (P < 0.05). There was also a statistically significant correlation between TNF-a levels and a higher degree of chondromalacia (P = 0.019). CONCLUSION An increase in inflammatory cytokines coupled with chondromalacia propose a more aggressive degenerative disease.
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Affiliation(s)
- Boaz Frenkel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 Ha'aliya St., Haifa, Israel
| | - Fadi Abu Shqara
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institution of Technology, Haifa, Israel.
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, 8 Ha'aliya St., Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institution of Technology, Haifa, Israel
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Role of Photobiomodulation Therapy in Modulating Oxidative Stress in Temporomandibular Disorders. A Systematic Review and Meta-Analysis of Human Randomised Controlled Trials. Antioxidants (Basel) 2021; 10:antiox10071028. [PMID: 34202292 PMCID: PMC8300797 DOI: 10.3390/antiox10071028] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 02/08/2023] Open
Abstract
This systematic review and meta-analysis (PROSPERO registration; ref CRD 42020198921) aimed to govern photobiomodulation therapy (PBMT) efficacy in temporomandibular disorder (TMD). PRISMA guidelines and Cochrane Collaboration recommendations were followed. Differences in pain reduction assessment by qualitative measurement with visual analogue scale pain (VAS), pressure threshold (PPT) and maximum mouth opening (MMO) were calculated with 95% confidence intervals and pooled in a random effects model with a subgroup analysis, evaluating the role of follow-up duration. Heterogeneity was analysed using Q and I2 tests. Publication bias was assessed by visual examination of funnel plot symmetry. Qualitative analysis revealed 46% of the 44 included studies showed a high risk of bias. Meta-analysis on 32 out of 44 studies revealed statistically significant intergroup differences (SSID) for VAS (SMD = -0.55; 95% CI = -0.82 to -0.27; Z = 3.90 (p < 0.001)), PPT (SMD = -0.45; 95% CI = -0.89 to 0.00; Z = 1.97 (p = 0.05)) and MMO (SMD = -0.45; 95% CI = -0.89 to 0.00; Z = 1.97 (p = 0.05)), favouring PBMT compared to control treatment strategies. Sensitivity analysis revealed SSID (SMD = -0.53; 95% CI = -0.73 to -0.32; Z = 5.02 (p < 0.0001)) with low heterogeneity (Τ2 = 0.02; χ2 = 16.03 (p = 0.31); I2 = 13%). Hence, this review, for first time, proposed suggested recommendations for PBMT protocols and methodology for future extensive TMD research.
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Eckstein FM, Wurm MC, Eckstein M, Wiesmüller M, Müller M, Jehn P, Söder S, Schlittenbauer T. Imaging, histopathological degree of degeneration and clinical findings - Do these correlate in patients with temporomandibular joint disorders. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:353-357. [PMID: 33991716 DOI: 10.1016/j.jormas.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
The gold standard for temporomandibular joint imaging is magnetic resonance imaging, although there are still pathological findings that cannot be seen in MRI but in surgery and the subsequent histological analysis only. The main goal of this investigation was to validate the MRI score used by histopathological findings as well as clinical findings. In this retrospective study 39 patients were included; 38 of which underwent unilateral and 1 underwent bilateral discectomy. MRI findings were graded according to the score by Wurm. Histopathological analysis was performed in hematoxylin-eosin staining and graded in accordance with the scores by Krenn and by Leonardi. For valuation of preoperative pain values of the temporomandibular joint operated on the numeric rating scale was utilized. Correlations were verified by Spearman-Rho. The MRI scores on average showed significantly lower scores for the discs of the operated temporomandibular joint than for the discs of the non-operated side(p<.01). No significant correlations between MRI findings, histopathological findings and pain intensities could be observed. Thus unsuspicious morphology of the TMJ and the articular disc in MRI is no guarantee for the absence of cartilage-degeneration. Further investigations utilizing T2 cartilage mapping could possibly show better correlations between the temporomandibular joint's degree of degeneration and imaging results.
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Affiliation(s)
- Fabian Matthias Eckstein
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen Nuremberg, Glückstraße 11, 91054 Erlangen, Germany; Department of Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Matthias Christian Wurm
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen Nuremberg, Glückstraße 11, 91054 Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-University of Erlangen-Nuremberg, Krankenhausstraße 8-10, 91054 Erlangen, Germany
| | - Marco Wiesmüller
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Magdalena Müller
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen Nuremberg, Glückstraße 11, 91054 Erlangen, Germany; Department of Oral and Maxillofacial Surgery, Katharinen Hospital, Stuttgart, Kriegsbergstraße 60, 70174 Stuttgart, Germany
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Stephan Söder
- Institute of Pathology, Friedrich-Alexander-University of Erlangen-Nuremberg, Krankenhausstraße 8-10, 91054 Erlangen, Germany
| | - Tilo Schlittenbauer
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen Nuremberg, Glückstraße 11, 91054 Erlangen, Germany; Section of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
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Cafferata EA, Monasterio G, Castillo F, Carvajal P, Flores G, Díaz W, Fuentes AD, Vernal R. Overexpression of MMPs, cytokines, and RANKL/OPG in temporomandibular joint osteoarthritis and their association with joint pain, mouth opening, and bone degeneration: A preliminary report. Oral Dis 2020; 27:970-980. [PMID: 32871032 DOI: 10.1111/odi.13623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/15/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed to determine the expression of distinct matrix metalloproteinases, cytokines, and bone resorptive factors in temporomandibular joint osteoarthritis (TMJ-OA) patients and their association with joint pain, mouth opening, and subchondral bone degeneration. MATERIALS AND METHODS Twelve patients affected with TMJ-OA (n = 5), disk displacement without reduction (DDWoR) (n = 3), or disk displacement with reduction (DDWR) (n = 4) were selected. Joint pain was quantified by using visual analog scale, mouth opening was quantified at the maximum pain-free aperture, and bone degeneration was quantified using joint imaging. Synovial fluid samples were collected and immediately processed for cell and synovial fluid recovering. From cells, the MMP-1, MMP-2, MMP-8, MMP-13, IL-6, IL-23, and TNF-α expression was quantified by qPCR. From synovial fluid, the RANKL and OPG levels were quantified by ELISA. RESULTS Higher levels of MMP-1, MMP-8, MMP-13, IL-6, IL-23, TNF-α, and RANKL/OPG ratio were detected in TMJ-OA compared with DDWoR and DDWR patients (p < .05). Joint pain significantly correlated with TNF-α levels (r = .975, p = .029). Besides, imaging signs of bone degeneration significantly correlated with RANKL/OPG ratio (r = .949, p = .042). Conversely, mouth opening did not correlate with any of the analyzed mediators. CONCLUSION During TMJ-OA, a pathological response characterized by the overexpression of TNF-α and RANKL/OPG could be involved in joint pain and subchondral bone degeneration.
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Affiliation(s)
- Emilio A Cafferata
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.,Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Lima, Perú
| | - Gustavo Monasterio
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Francisca Castillo
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Paola Carvajal
- Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Guillermo Flores
- Department of Prosthesis, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Walter Díaz
- Department of Prosthesis, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Aler D Fuentes
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.,Oral Physiology Laboratory, Faculty of Medicine, Biomedical Sciences Institute, Universidad de Chile, Santiago, Chile
| | - Rolando Vernal
- Periodontal Biology Laboratory, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.,Department of Conservative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
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Braz MA, Freitas Portella F, Seehaber KA, Bavaresco CS, Rivaldo EG. Association between oxidative stress and temporomandibular joint dysfunction: A narrative review. J Oral Rehabil 2020; 47:536-546. [PMID: 31880832 DOI: 10.1111/joor.12930] [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: 07/29/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The role of oxidative stress in temporomandibular disorders (TMDs) has been studied using synovial fluid, to evaluate oxidative stress (im)balance and its potential role in the onset and/or progression of the disease. OBJECTIVE This review aimed to evaluate the association between oxidative stress markers and the etiopathogenesis of TMJ dysfunction by means of synovial fluid analysis. METHODS Two independent reviewers searched the electronic databases from inception to March 2019: PubMed/MEDLINE, LILACS, SciELO, EMBASE, TRIPDATABASE, SCOPUS, and Google Scholar. The following key search terms were used: Temporomandibular Joint Disorders OR Temporomandibular Joint Disc OR Temporomandibular Joint Dysfunction Syndrome OR Temporomandibular Joint OR Facial Pain AND Free Radicals OR Oxidative Stress. Data were extracted from the selected articles, including study design, sample profile, TMJ disease reported, diagnostic method, reactive oxygen and nitrogen species evaluated, enzymatic and non-enzymatic antioxidants evaluated, and techniques used to measure free radicals and antioxidants. RESULTS After title and abstract screening of 6974 results, and full-text reading, 19 studies were included. All selected articles were cross-sectional observational studies. Enzymatic and non-enzymatic antioxidant defences appeared to be reduced in these patients, resulting in the establishment of the oxidative stress process. In addition, the studies showed a positive correlation between the severity of the intra-articular TMD and the increase in oxidative damage. CONCLUSION The establishment of oxidative stress, whether by an increase in reactive oxygen/nitrogen species or by a decrease in antioxidant defences, or a combination of both, may be associated with the establishment and maintenance of intra-articular damage.
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Affiliation(s)
- Marcylene Arruda Braz
- Programa de Pós-Graduação em Odontologia, Universidade Luterana do Brasil, Canoas, Brazil
| | - Fernando Freitas Portella
- Programa de Pós-Graduação em Odontologia, Universidade Luterana do Brasil, Canoas, Brazil.,Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, Brazil
| | - Karin Astrid Seehaber
- Programa de Pós-Graduação em Odontologia, Universidade Luterana do Brasil, Canoas, Brazil
| | - Caren Serra Bavaresco
- Programa de Pós-Graduação em Odontologia, Universidade Luterana do Brasil, Canoas, Brazil
| | - Elken Gomes Rivaldo
- Programa de Pós-Graduação em Odontologia, Universidade Luterana do Brasil, Canoas, Brazil
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