The effect of collagen reinforcement in the behaviour of the temporomandibular joint disc

Finite element analysis of various thickness occlusal stabilization splint therapy on unilateral temporomandibular joint anterior disc displacement without reduction

INTRODUCTION

Occlusal stabilization splint is the most common treatment modality for temporomandibular joint disorders, but the optimal thickness is still uncertain. This study investigated the effect of the occlusal splint with different thicknesses on the stress distribution of the temporomandibular joint.

METHODS

Cone-beam computed tomography and magnetic resonance images were used to reconstruct the maxillofacial and disc, and the unilateral anterior disc displacement without reduction was established manually as the basic model. Occlusal splint with 5 different thickness levels (2, 3, 4, 5, and 6 mm) was added to the basic model as the study models. The displacement and stress distribution of the disc were evaluated.

RESULTS

The maximum von Mises stress of the condylar cartilage was the largest on the affected side, whereas the maximum von Mises stress of the disc was the largest on the unaffected side. The disc stress on the affected side was mainly distributed on the posterior zone and the intermediate zone for the unaffected side. The maximum von Mises stress of the bilaminar region on the affected side was greater than the unaffected side. The stress of the disc and bilaminar region was the lowest on the affected side in the 2 mm model. The disc displacement on the affected side gradually increased, whereas, on the unaffected side, it fluctuated.

CONCLUSIONS

These results showed that occlusal stabilization splint could decrease the stress of disc and bilaminar region, and 2 mm was considered the optimal thickness for the treatment of unilateral temporomandibular joint anterior disc displacement without reduction.

Biomechanical impact of the porous-fibrous tissue behaviour in the temporomandibular joint movements. An in silico approach

The movement of the temporomandibular joint (TMJ) is a function of its complex geometry and its interaction with the surrounding soft tissues. Owing to an increase in the prevalence of temporomandibular joint disorders (TMDs), many computational studies have attempted to characterize its biomechanical behaviour in the last 2 decades. However, most such studies are based on a single computational model that markedly simplifies the complex geometry and mechanical properties of the TMJ's soft tissues. The present study aims to computationally evaluate in a wider sample the importance of considering their complex anatomy and behaviour for simulating both damping and motion responses of this joint. Hence, 6 finite element models of healthy volunteers' TMJ were developed and subjected to both conditions in two different behavioural scenarios. In one, the soft tissues' behaviour was modelled by considering the porous-fibrous properties, whereas in the other case they were simplified assuming isotropic-hyperelastic response, as had been traditionally considered. The damping analysis, which mimic the conditions of an experimental test of the literature, consisted of applying two different compressive loads to the jaw. The motion analysis evaluated the condylar path during the mandible centric depression by the action of muscular forces. From the results of both analyses, the contact pressures, intra-articular fluid pressure, path features, and stress/strain values were compared using the porous-fibrous and isotropic-hyperelastic models. Besides the great differences observed between patients due patient-specific morphology, the porous-fibrous approach yielded results closer to the reference experimental values and to the outcomes of other computational studies of the literature. Our findings underscore, therefore, the importance of considering realistic joint geometries and porous-fibrous contribution in the computational modelling of the TMJ, but also in the design of further joint replacements or in the development of new biomaterials for this joint.

Effect of Occlusal Splints on the Stress Distribution on the Temporomandibular Joint Disc

Conservative approach, including occlusal splint therapy, is the first option to treat temporomandibular disorders (TMD), because of its reversibility. The present study analyzed the effect of the articular disc position and occlusal splints use on the stress distribution on this disc. A two-dimensional (2D) finite element (FE) model of the temporomandibular joint with the articular disc at its physiologic position was constructed based on cone-beam computed tomography. Three other FE models were created changing the disc position, according to occlusal splint use and anterior disc displacement condition. Structural stress distribution analysis was performed using Marc-Mentat package. The equivalent von Mises stress was used to compare the study factor. Higher stress concentration was observed on the intermediate to anterior zone of the disc, with maximum values over 2MPa. No relevant difference was verified on the stress distribution and magnitude comparing disc positions and occlusal splint use. However, there was stress reduction arising from the use of the occlusal splints in cases of anterior disc displacement. In conclusion, based on the generated FE models and established boundary conditions, the stress increased at the intermediate zone of the TMJ disc during physiological mandible closure. The stress magnitude was similar in all tested situations.

Regionally variant collagen alignment correlates with viscoelastic properties of the disc of the human temporomandibular joint

OBJECTIVE

To determine the regionally variant quality of collagen alignment in human TMJ discs and its statistical correlation with viscoelastic properties.

DESIGN

For quantitative analysis of the quality of collagen alignment, horizontal sections of human TMJ discs with Pricrosirius Red staining were imaged under circularly polarized microscopy. Mean angle and angular deviation of collagen fibers in each region were analyzed using a well-established automated image-processing for angular gradient. Instantaneous and relaxation moduli of each disc region were measured under stress-relaxation test both in tensile and compression. Then Spearman correlation analysis was performed between the angular deviation and the moduli. To understand the effect of glycosaminoglycans on the correlation, TMJ disc samples were treated by chondroitinase ABC (C-ABC).

RESULTS

Our imaging processing analysis showed the region-variant direction of collagen alignment, consistently with previous findings. Interestingly, the quality of collagen alignment, not only the directions, was significantly different in between the regions. The angular deviation of fiber alignment in the anterior and intermediate regions were significantly smaller than the posterior region. Medial and lateral regions showed significantly bigger angular deviation than all the other regions. The regionally variant angular deviation values showed statistically significant correlation with the tensile instantaneous modulus and the relaxation modulus, partially dependent on C-ABC treatment.

CONCLUSION

Our findings suggest the region-variant degree of collagen fiber alignment is likely attributed to the heterogeneous viscoelastic properties of TMJ disc that may have significant implications in development of regenerative therapy for TMJ disc.

The contribution of collagen fibers to the mechanical compressive properties of the temporomandibular joint disc

OBJECTIVE

The Temporomandibular Joint (TMJ) disc is a fibrocartilaginous structure located between the mandibular condyle and the temporal bone, facilitating smooth movements of the jaw. The load-bearing properties of its anisotropic collagenous network have been well characterized under tensile loading conditions. However, recently it has also been speculated that the collagen fibers may contribute dominantly in reinforcing the disc under compression. Therefore, in this study, the structural-functional role of collagen fibers in mechanical compressive properties of TMJ disc was investigated.

DESIGN

Intact porcine TMJ discs were enzymatically digested with collagenase to disrupt the collagenous network of the cartilage. The digested and non-digested articular discs were analyzed mechanically, biochemically and histologically in five various regions. These tests included: (1) cyclic compression tests, (2) biochemical quantification of collagen and glycosaminoglycan (GAG) content and (3) visualization of collagen fibers' alignment by polarized light microscopy (PLM).

RESULTS

The instantaneous compressive moduli of the articular discs were reduced by as much as 50-90% depending on the region after the collagenase treatment. The energy dissipation properties of the digested discs showed a similar tendency. Biochemical analysis of the digested samples demonstrated an average of 14% and 35% loss in collagen and GAG, respectively. Despite the low reduction of collagen content the PLM images showed considerable perturbation of the collagenous network of the TMJ disc.

CONCLUSIONS

The results indicated that even mild disruption of collagen fibers can lead to substantial mechanical softening of TMJ disc undermining its reinforcement and mechanical stability under compression.

The Biomechanical Effect of Different Denture Base Materials on the Articular Disc in Complete Denture Wearers: A Finite Element Analysis

AIM:

The objective of the present study was to evaluate the effect of different denture base materials on the stress distribution in TMJ articular disc (AD) in complete denture wearers.

MATERIAL AND METHODS:

A three dimensional Finite Element (FEA) models of an individual temporomandibular joint (TMJ) was built on the basis CT scan. The FEA model consisted of four parts: the condyle, the articular disc, the denture base, and the articular eminence skull. Acrylic resin and chrome-cobalt denture base materials were studied. Static loading of 300N was vertically applied to the central fossa of the mandibular second premolar. Stress and strain were calculated to characterize the stress/strain patterns in the disc.

RESULTS:

The maximum tensile stresses were observed in the anterior and posterior bands of (AD) on load application with the two denture base materials. The superior boundaries of the glenoid fossa showed lower stress than those on the inferior boundaries facing the condyle.

CONCLUSIONS:

Within the limitations of the present study it may be concluded that: The denture base material may have an effect in stress-strain pattern in TMJ articular disc. The stiffer denture base material, the better the distribution of the load to the underling mandibular supporting structures & reducing stresses induced in the articular disc.

The stock alloplastic temporomandibular joint implant can influence the behavior of the opposite native joint: A numerical study

PURPOSE

The objective of the study was to investigate the effect of total stock temporomandibular implants on load mechanisms in both condyles in a specific patient. The patient presented with a disc with wear, and the introduction of a total temporomandibular prosthesis was simulated to compare the articular behavior.

MATERIAL AND METHODS

Based on specific patient computed tomographic images, two finite element models were created: one model with two intact temporomandibular joints (one joint with pathology), and other model with one implanted joint. The simulations considered the five most important muscles acting in the mandible, and it was possible to evaluate the biomechanical changes in the structures (skull, mandible, and articular disc).

RESULTS

The results revealed more load transfer in the opposite condyle than in the damaged one; the insertion of a total temporomandibular implant changed the load transfer to the opposite condyle. There was decreased stress in the disc by about 50% and increased strain distribution. In the mandibular condyle with implant, the screw fixation is critical, with minimum strain around -9430 με for first screw position. In the cranium, the implant changed the bone strains with a minimum principal strain observed around -2500 με in six screw positions.

CONCLUSION

This study indicates that replacing the damaged joint by an implant in an ideal position will improve joint position and consequently redistribute the loads. The study findings provide strong evidence that placing an implant on one side of the mandible will affect the load distribution on that structure and particularly on the opposite side. The temporomandibular joint changes condyle movement; with an implanted condyle, the movement is almost blocked.

Effect of jaw opening on the stress pattern in a normal human articular disc: finite element analysis based on MRI images

INTRODUCTION

Excessive compressive and shear stresses are likely related to condylar resorption and disc perforation. Few studies have reported the disc displacement and deformation during jaw opening. The aim of this study was to analyze stress distribution in a normal articular disc during the jaw opening movement.

METHODS

Bilateral MRI images were obtained from the temporomandibular joint of a healthy subject for the jaw opening displacement from 6 to 24 mm with 1 mm increments. The disc contour for the jaw opening at 6 mm was defined as the reference state, and was used to establish a two dimensional finite element model of the disc. The contours of the disc at other degrees of jaw opening were used as the displacement loading. Hyperelastic material models were applied to the anterior, intermediate and posterior parts of the disc. Stress and strain trajectories were calculated to characterize the stress/strain patterns in the disc.

RESULTS

Both the maximum and minimum principal stresses were negative in the intermediate zone, therefore, the intermediate zone withstood mainly compressive stress. On the contrary, the maximum and minimum principal stresses were most positive in the anterior and posterior zones, which meant that the anterior and posterior bands suffered higher tensile stresses. The different patterns of stress trajectories between the intermediate zone and the anterior and posterior bands might be attributed to the effect of fiber orientation. The compression of the intermediate zone and stretching of the anterior and posterior bands caused high shear deformation in the transition region, especially at the disc surfaces.

CONCLUSIONS

The stress and strain remained at a reasonable level during jaw opening, indicating that the disc experiences no injury during functional opening movements in a healthy temporomandibular joint.

A study of the temporomandibular joint during bruxism

A finite element model of the temporomandibular joint (TMJ) and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear viscoelastic model was used to simulate the behaviour of the disc. The viscoelastic nature of this tissue is shown to be an important factor when sustained (awake bruxism) or cyclic loading (sleep bruxism) is simulated. From the comparison of the two types of bruxism, it was seen that sustained clenching is the most detrimental activity for the TMJ disc, producing an overload that could lead to severe damage of this tissue.

Numerical simulation of a relaxation test designed to fit a quasi-linear viscoelastic model for temporomandibular joint discs

The main objectives of this work are: (a) to introduce an algorithm for adjusting the quasi-linear viscoelastic model to fit a material using a stress relaxation test and (b) to validate a protocol for performing such tests in temporomandibular joint discs. This algorithm is intended for fitting the Prony series coefficients and the hyperelastic constants of the quasi-linear viscoelastic model by considering that the relaxation test is performed with an initial ramp loading at a certain rate. This algorithm was validated before being applied to achieve the second objective. Generally, the complete three-dimensional formulation of the quasi-linear viscoelastic model is very complex. Therefore, it is necessary to design an experimental test to ensure a simple stress state, such as uniaxial compression to facilitate obtaining the viscoelastic properties. This work provides some recommendations about the experimental setup, which are important to follow, as an inadequate setup could produce a stress state far from uniaxial, thus, distorting the material constants determined from the experiment. The test considered is a stress relaxation test using unconfined compression performed in cylindrical specimens extracted from temporomandibular joint discs. To validate the experimental protocol, the test was numerically simulated using finite-element modelling. The disc was arbitrarily assigned a set of quasi-linear viscoelastic constants (c1) in the finite-element model. Another set of constants (c2) was obtained by fitting the results of the simulated test with the proposed algorithm. The deviation of constants c2 from constants c1 measures how far the stresses are from the uniaxial state. The effects of the following features of the experimental setup on this deviation have been analysed: (a) the friction coefficient between the compression plates and the specimen (which should be as low as possible); (b) the portion of the specimen glued to the compression plates (smaller areas glued are better); and (c) the variation in the thickness of the specimen. The specimen’s faces should be parallel to ensure a uniaxial stress state. However, this is not possible in real specimens, and a criterion must be defined to accept the specimen in terms of the specimen’s thickness variation and the deviation of the fitted constants arising from such a variation.

Regional annulus fibre orientations used as a tool for the calibration of lumbar intervertebral disc finite element models

The collagen network of the annulus fibrosus largely controls the functional biomechanics of the lumbar intervertebral discs (IVDs). Quantitative anatomical examinations have shown bundle orientation patterns, possibly coming from regional adaptations of the annulus mechanics. This study aimed to show that the regional differences in annulus mechanical behaviour could be reproduced by considering only fibre orientation changes. Using the finite element method, a lumbar annulus was modelled as a poro-hyperelastic material in which fibres were represented by a direction-dependent strain energy density term. Fibre orientations were calibrated to reproduce the annulus tensile behaviours measured for four different regions: posterior outer, anterior outer, posterior inner and anterior inner. The back-calculated fibre angles and regional patterns as well as the global disc behaviour were comparable with anatomical descriptions reported in the literature. It was concluded that annulus fibre variations might be an effective tool to calibrate lumbar spine IVD and segment models.

Tensile stress patterns predicted in the articular disc of the human temporomandibular joint

The direction of the first principal stress in the articular disc of the temporomandibular joint was predicted with a biomechanical model of the human masticatory system. The results were compared with the orientation of its collagen fibers. Furthermore, the effect of an active pull of the superior lateral pterygoid muscle, which is directly attached to the articular disc, was studied. It was hypothesized that the markedly antero-posterior direction of the collagen fibers would be reflected in the direction of the tensile stresses in the disc and that active pull of the superior lateral pterygoid muscle would augment these tensions. It was found that the tensile patterns were extremely dependent on the stage of movement and on the mandibular position. They differed between the superior and inferior layers of the disc. The hypothesis could only be confirmed for the anterior and middle portions of the disc. The predicted tensile principal stresses in the posterior part of the disc alternated between antero-posterior and medio-lateral directions.

Temporomandibular joint: disorders, treatments, and biomechanics

Temporomandibular joint (TMJ) is a complex, sensitive, and highly mobile joint. Millions of people suffer from temporomandibular disorders (TMD) in USA alone. The TMD treatment options need to be looked at more fully to assess possible improvement of the available options and introduction of novel techniques. As reconstruction with either partial or total joint prosthesis is the potential treatment option in certain TMD conditions, it is essential to study outcomes of the FDA approved TMJ implants in a controlled comparative manner. Evaluating the kinetics and kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of treatment. Although many researchers have conducted biomechanical analysis of the TMJ, many of the methods have certain limitations. Therefore, a more comprehensive analysis is necessary for better understanding of different movements and resulting forces and stresses in the joint components. This article provides the results of a state-of-the-art investigation of the TMJ anatomy, TMD, treatment options, a review of the FDA approved TMJ prosthetic devices, and the TMJ biomechanics.

Biomechanical properties of the mandibular condylar cartilage and their relevance to the TMJ disc

Mandibular condylar cartilage plays a crucial role in temporomandibular joint (TMJ) function, which includes facilitating articulation with the TMJ disc, reducing loads on the underlying bone, and contributing to bone remodeling. To improve our understanding of the TMJ function in normal and pathological situations, accurate and validated three-dimensional (3-D) finite element models (FEMs) of the human TMJ may serve as valuable diagnostic tools as well as predictors of thresholds for tissue damage resulting from parafunctional activities and trauma. In this context, development of reliable biomechanical standards for condylar cartilage is crucial. Moreover, biomechanical characteristics of the native tissue are important design parameters for creating functional tissue-engineered replacements. Towards these goals, biomechanical characteristics of the condylar cartilage have been reviewed here, highlighting the structure-function correlations. Structurally, condylar cartilage, like the TMJ disc, exhibits zonal and topographical heterogeneity. Early structural investigations of the condylar cartilage have suggested that the tissue possesses a somewhat transversely isotropic orientation of collagen fibers in the fibrous zone. However, recent tensile and shear evaluations have reported a higher stiffness of the tissue in the anteroposterior direction than in the mediolateral direction, corresponding to an anisotropic fiber orientation comparable to the TMJ disc. In a few investigations, condylar cartilage under compression was found to be stiffer anteriorly than posteriorly. As with the TMJ disc, further compressive characterization is warranted. To draw inferences for human tissue using animal models, establishing stiffness-thickness correlations and regional evaluation of proteoglycan/glycosaminoglycan content may be essential. Efforts directed from the biomechanics community for the characterization of TMJ tissues will facilitate the development of reliable and accurate 3-D FEMs of the human TMJ.

Comparative evaluation on three-dimensional finite element models of the temporomandibular joint

BACKGROUND

The loads in the temporomandibular joint (TMJ) have been proven to play an important role in its structure and function as well as the etiology and therapy of TMJ disorders. Up to now, finite element (FE) models have been largely used to analyze the stress distributions in TMJs. The disc and the articular surfaces in the TMJs were simulated to be bonded together in many models. In addition, gap elements or contact elements were used to simulate the interaction of the disc and the articular surfaces. However, the comparative evaluation of the three simulations of TMJs has not been studied.

METHODS

Three FE models were developed to compare the differences of the simulations on the biomechanics of the TMJs according to the CT images of a volunteer. The interfaces between the discs and the articular cartilages were bonded together and treated as gap elements or contact elements. The muscle forces corresponding to centric occlusion were applied to the three models.

FINDINGS

The stresses in the TMJs were observed to increase in the model with bonded discs and articular cartilages. Gap elements between the discs and the cartilages resulted in the slight magnitude of stresses and the abnormal movement and stress distribution in the TMJs. The condyles and the discs were in the normal position and the stress distributions in the TMJs were similar to the normal biomechanical states when contact elements were simulated between the disc and the cartilages.

INTERPRETATION

The reasonable simulation of the TMJs was to treat the interfaces between the discs and the cartilages as contact elements. The reliable simulation could contribute to the understanding of the stress distributions in TMJs and the basis for the prevention and therapy of the TMJ disorders.

Dynamic 3D FE modelling of the human temporomandibular joint during whiplash

Rear-end impacts account for more than one-third of vehicle accidents, and nearly 40% of these accidents produce whiplash injuries. Whiplash injury to the neck has often been considered a significant risk factor for the development of temporomandibular disorders (TMD). The objective of this study was to simulate the dynamic response of the temporomandibular joint during two types of impacts: a rear end and a frontal impact. To understand the dynamic forces acting on the joint, we extended a previous human temporomandibular joint model and analyzed the stress distributions in the soft elements of the joint. In the rear-end impact, it could be appreciated that the inertia of the mandible caused it to move posteriorly slower than the head, and this resulted in downward and forward displacements of the disc-condyle complex relative to the cranial base. Consequently, a rapid and big mouth opening occurs. In contrast, during the frontal impact, the mouth hardly opened, because the superior maxilla pushed the mandible to move together. There was not differential movement between bony components of the joint and therefore the soft tissues of the joint were not subjected to high loads. From these results, and despite the limitations of the simulations performed, we could conclude that neither a rear-end impact at low-velocity nor a frontal impact would produce damage to the soft tissues of the joint.

A mechanical evaluation of three decellularization methods in the design of a xenogeneic scaffold for tissue engineering the temporomandibular joint disc

Tissue-engineered temporomandibular joint (TMJ) discs offer a viable treatment option for patients with severe joint internal derangement. To date, only a handful of TMJ tissue engineering studies have been carried out and all have incorporated the use of synthetic scaffold materials. These current scaffolds have shown limited success in recapitulating morphological and functional aspects of the native disc tissue. The present study is the first to investigate the potential of a xenogeneic scaffold for use in tissue engineering the TMJ disc. The effects of decellularization agents on the disc's mechanical properties were assessed using three common decellularization protocols: Triton X-100, sodium dodecyl sulfate (SDS) and an acetone/ethanol solution. Decellularized scaffolds were subsequently characterized through cyclic mechanical testing at physiologically relevant frequencies to determine which chemical agent most accurately preserved the native tissue properties. Results have shown that porcine discs treated with SDS most closely matched the energy dissipation capabilities and resistance to deformation of the native tissue. Treatments using Triton X-100 caused the resultant tissue to become relatively softer with inferior energy dissipation capabilities, while treatment using acetone/ethanol led to a significantly stiffer and dehydrated material. These findings support the potential of a porcine-derived scaffold decellularized by SDS as a xenograft for TMJ disc reconstruction.

Influence of unilateral disc displacement on the stress response of the temporomandibular joint discs during opening and mastication

The temporomandibular joint plays a crucial role in human mastication acting as a guide of jaw movements. During these movements, the joint is subjected to loads which cause stresses and deformations in its cartilaginous structures. A perfect balance between the two sides of the joint is essential to maintain the physiological stress level within the tissues. Therefore, it has been suggested that a derangement of the joint is a contributing factor in the development of mandibular asymmetry, especially if problems of the temporomandibular joint start in childhood or adolescence. To analyze the movement of the mandible and the stresses undergone by the discs, two finite element models of the human temporomandibular joint including the masticatory system were developed, one corresponding to a healthy joint and the other with a unilateral anterior disc displacement with their movement controlled by muscle activation. A fibre-reinforced porohyperelastic model was used to simulate the behaviour of the articular discs. The stress distribution was analyzed in both models during free opening and closing, and during the introduction of a resistant force between incisors or molars. It was found that a slight unilateral anterior disc displacement does not lead to mandibular asymmetry but to a slight decrease of the maximum gape. With the introduction of a restriction between incisors, the maximum stresses moved to the anterior band in contrast to what happened if the restriction was imposed between molars where maximum stresses were located more posteriorly. Finally, the presence of a unilateral displacement of the disc involved a strong change in the overall behaviour of the joint including also the healthy side, where the maximum stresses moved to the posterior part.

Effect of Hyperactivity of the Lateral Pterygoid Muscle on the Temporomandibular Joint Disk

In this study, the effect of hyperactivity of the lateral pterygoid muscle (LPM) on the temporomandibular joint (TMJ) disk during prolonged clenching was examined with a mathematical model. Finite element models of the TMJ were constructed based on magnetic resonance images from two subjects with or without internal derangement of the TMJ. For each model, muscle forces were used as a loading condition for stress analysis for 10 min clenching. Furthermore, an intermittent increase of the LPM force with intervals of 1 min was applied. In the asymptomatic model, large stresses were found in the central and lateral part of the disk at the onset of clenching. In the retrodiscal tissue, stress relaxation occurred during the first 2 min of clenching. When the force of the LPM increased temporarily, the disk moved anteriorly and returned to its original position afterward. In the symptomatic model, large stresses were observed in both the posterior region of the disk and the retrodiscal tissue throughout clenching. Upon temporary increase of the LPM force, the disk was elongated anteriorly, which appeared to be irreversible. These results indicate that hyperactivity of the LPM may be involved in the progression of disk displacement.

A call to action for bioengineers and dental professionals: directives for the future of TMJ bioengineering

The world's first TMJ Bioengineering Conference was held May 25-27, 2006, in Broomfield, Colorado. Presentations were given by 34 invited speakers representing industry, academics, government agencies such as NIH, and private practice, which included surgeons, engineers, biomedical scientists, and patient advocacy leaders. Other attendees included documentary film makers and FDA officials. The impetus for the conference was that the field of TMJ research has been lacking continuity, with no open forum available for surgeons, scientists, and bioengineers to exchange scientific and clinical ideas and identify common goals, strengths, and capabilities. The goal was thus to plant the seeds for establishing a forum for multidisciplinary and interdisciplinary interactions. The collective wisdom and interactions brought about by a melting pot of these diverse individuals has been pooled and is disseminated in this article, which offers specific directives to bioengineers, basic scientists, and medical and dental professionals including oral and maxillofacial surgeons, pain specialists, orthodontists, prosthodontists, endocrinologists, rheumatologists, immunologists, radiologists, neurologists, and orthopaedic surgeons. A primary goal of this article was to attract researchers across a breadth of research areas to lend their expertise to a significant clinical problem with a dire need for new talent. For example, researchers with expertise in finite element modeling will find an extensive list of clinically significant problems. Specific suggestions for TMJ research were presented by the leading organizations for TMJ surgeons and TMJ patients, and further research needs were identified in a series of group discussions. The specific needs identified at the conference and presented here will be essential for those who endeavor to engage in TMJ research, especially in the areas of tissue engineering and biomechanics. Collectively, it is our hope that many of the questions and directives presented here find their way into the proposals of multidisciplinary teams across the world with new and promising approaches to diagnose, prevent and treat TMJ disorders.

An accurate simulation model of anteriorly displaced TMJ discs with and without reduction

Internal derangement of the temporomandibular joint (TMJ) is defined as an abnormal positional relationship of the disc relative to the mandibular condyle and the glenoid fossa. Among others, the anterior disc displacement is the most common disorder, however its origin and consequences are still unclear. Several finite element simulations of the TMJ have been developed, but none of them has reported dynamic simulations of the disc as a three-dimensional, fiber-reinforced biphasic material under finite deformations, during the opening movement of a pathologic joint affected of an anterior displacement of the disc with and without reduction, using a realistic geometry of the ligaments in the joint. The aim of the work presented here was to compare the stress distribution in the healthy joint and in two pathologic situations, one joint affected of an anterior disc displacement with reduction (ADDWR) and one without reduction (ADDWOR) during an opening movement of the mouth. It was found that, while in the healthy disc the highest compressive stresses were located in the intermediate zone, in the pathologic joints the maximum compressive stresses were located in the posterior band both in the ADDWOR case and in the ADDWR before the reduction. Moreover, although the final stress distribution in the ADDWR was similar to that in the healthy case, the collateral ligaments supported higher stresses, a fact that could lead to degeneration of these components and subsequently to the total anterior displacement of the disc. Finally, the results suggest that an anterior displacement of the disc would lead to higher compressive and tangential stresses in the posterior band of the disc than in the healthy one, and as a consequence, to possible perforations in that zone of the disc which would modify its geometry if no treatment is applied.

Prediction of volumetric strain in the human temporomandibular joint cartilage during jaw movement

Human temporomandibular joint loading causes pressurization and flow of interstitial fluid in its cartilaginous structures. This largely determines its load-bearing and maintenance capacity. It was hypothesized that during cyclical jaw movements normal pressure distribution dynamics would enable fluid to reach all necessary cartilage regions. This was tested qualitatively by analysis of local volumetric strain dynamics during jaw open-close movements predicted by a dynamic model of the human masticatory system. Finite-element analysis was performed in separate regions of the articular cartilage layers and articular disc. Heterogeneous patterns of dilatation and compression were predicted. Compression was found to be more dominant during jaw closing than opening. The pressure gradient in the superior layer of the articular disc was more mediolaterally orientated than in its inferior layer. The findings suggest that, where necessary, regionally the cartilage can imbibe fluid to protect the subchondral bone from impact loads effectively. In the disc itself presumably all areas receive regular refreshment of interstitial fluid.

Anterior displacement of the TMJ disk: repositioning of the disk using a Mitek system. A 3D finite element study

In this paper the behaviors of the temporomandibular joint (TMJ) with an anteriorly displaced disk without reduction and with a surgically repositioned one were compared with the response of a healthy disk during jaw opening. The movement of each joint was obtained imposing the same opening path between incisors and assuming that the movement of the condyle is determined by the passive action of the masticatory muscles and the restrictions imposed by the articulating surfaces and the ligaments. A fiber-reinforced porohyperelastic model was used to simulate the behavior of the articular disk. The influence of the friction coefficient in the diseased joint was also analyzed, finding that the final displacement of the complex condyle-disk was smaller as the friction coefficient increased. On the other hand, its displacement in the repositioned joint was different than in the healthy case because the artificial sutures used in the surgery do not fully stabilize the disk posteriorly as the retrodiscal tissue does. The stress response of the disk changed in both pathologic cases: in the displaced joint the highest stresses moved from the intermediate zone (healthy case) to the posterior band, and in the reconstructed one the most loaded zone moved posteriorly at total opening. Besides, local stress concentrations appeared in the neighborhood of the artificial sutures and therefore damage of the disk and releasing of the sutures might be possible postoperatively.

3D Finite Element Simulation of the Opening Movement of the Mandible in Healthy and Pathologic Situations

One of the essential causes of disk disorders is the pathologic change in the ligamentous attachments of the disk-condyle complex. In this paper, the response of the soft components of a human temporomandibular joint during mouth opening in healthy and two pathologic situations was studied. A three-dimensional finite element model of this joint comprising the bone components, the articular disk, and the temporomandibular ligaments was developed from a set of medical images. A fiber reinforced porohyperelastic model was used to simulate the behavior of the articular disk, taking into account the orientation of the fibers in each zone of this cartilage component. The condylar movements during jaw opening were introduced as the loading condition in the analysis. In the healthy joint, it was obtained that the highest stresses were located at the lateral part of the intermediate zone of the disk. In this case, the collateral ligaments were subject to high loads, since they are responsible of the attachment of the disk to the condyle during the movement of the mandible. Additionally, two pathologic situations were simulated: damage of the retrodiscal tissue and disruption of the lateral discal ligament. In both cases, the highest stresses moved to the posterior part of the disk since it was displaced in the anterior-medial direction. In conclusion, in the healthy joint, the highest stresses were located in the lateral zone of the disk where perforations are found most often in the clinical experience. On the other hand, the results obtained in the damaged joints suggested that the disruption of the disk attachments may cause an anterior displacement of the disk and instability of the joint.