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Effat KG. Chronic craniomandibular pain after craniotomy: A long-term clinical study. Cranio 2022:1-8. [PMID: 36503374 DOI: 10.1080/08869634.2022.2154930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Chronic craniomandibular/cervical pain and temporomandibular disorders have not been studied in patients who had a craniotomy several years previously. The aim of the current clinical work was to address these issues. METHODS A total group of 150 ambulant patients who had a previous craniotomy was subclassified according to whether or not the temporalis muscle was manipulated. RESULTS The average incidence of multiple subsite regional head and neck pain was 69.3% a number of years after a craniotomy. Evidence of internal derangement of the temporomandibular joint was significantly higher in the group that required manipulation of the temporalis muscle during the procedure. CONCLUSION The pattern of chronic craniomandibular/cervical pain experienced years after a craniotomy supports the brain neuromatrix theory of pain.
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Affiliation(s)
- Kamal G Effat
- Department of Otolaryngology, El- Sahel Teaching Hospital, Cairo, Egypt
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2
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Puricelli E. Puricelli biconvex arthroplasty as an alternative for temporomandibular joint reconstruction: description of the technique and long-term case report. Head Face Med 2022; 18:27. [PMID: 35906643 PMCID: PMC9335964 DOI: 10.1186/s13005-022-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up. Case presentation In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components. Conclusions The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis.
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Affiliation(s)
- Edela Puricelli
- Oral and Maxillofacial Surgery Unit/ Clinical Hospital of Porto Alegre (HCPA), School of Dentistry/Federal University of Rio Grande Do Sul (UFRGS), Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
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3
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Scolaro A, Khijmatgar S, Rai PM, Falsarone F, Alicchio F, Mosca A, Greco C, Del Fabbro M, Tartaglia GM. Efficacy of Kinematic Parameters for Assessment of Temporomandibular Joint Function and Disfunction: A Systematic Review and Meta-Analysis. Bioengineering (Basel) 2022; 9:bioengineering9070269. [PMID: 35877320 PMCID: PMC9311583 DOI: 10.3390/bioengineering9070269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this review was to answer the following PICO question: “Do TMJ kinematic parameters (intervention and comparison) show efficacy for assessment of mandibular function (Outcome) both in asymptomatic and TMD subjects? (Population)”. PubMed, Scopus, Web of Science, Embase, Central databases were searched. The inclusion criteria were (1) performed on human, (2) English only, (3) on healthy, symptomatic or surgically altered TMJ, (4) measured dynamic kinematics of mandible or TMJ (5) with six degrees of freedom. To assess the Risk of Bias, the Joanna Briggs Institute tool for non-randomised clinical studies was employed. A pairwise meta-analysis was carried out using STATA v.17.0 (Stata). The heterogeneity was estimated using the Q value and the inconsistency index. Ninety-two articles were included in qualitative synthesis, nine studies in quantitative synthesis. The condylar inclination was significantly increased in female (effect size 0.03°, 95% CI: −0.06, 0.12, p = 0.00). Maximum mouth opening (MMO) was increased significantly in female population in comparison with males (effect size 0.65 millimetres (0.36, 1.66). Incisor displacement at MMO showed higher values for control groups compared with TMD subjects (overall effect size 0.16 millimetres (−0.37, 0.69). Evidence is still needed, considering the great variety of devices and parameters used for arthrokinematics. The present study suggests standardising outcomes, design, and population of the future studies in order to obtain more reliable and repeatable values.
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Affiliation(s)
- Alessandra Scolaro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Pooja Mali Rai
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Francesca Falsarone
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Francesca Alicchio
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Arianna Mosca
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
| | - Christian Greco
- Azienda Sanitaria dell’Alto Adige, Merano Hospital, 39100 Bolzano, Italy;
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- IRCC Orthopaedic Institute Galeazzi, 20161 Milan, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy; (A.S.); (S.K.); (P.M.R.); (M.D.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.F.); (F.A.); (A.M.)
- Correspondence:
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4
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Effat KG. A clinical study on the incidence of internal derangement of the temporomandibular joint following harvesting of temporalis fascia. Cranio 2022:1-8. [PMID: 35514168 DOI: 10.1080/08869634.2022.2072452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the current clinical study was to reveal whether harvesting of a temporalis fascia graft would be associated with a higher incidence of temporomandibular joint (TMJ) internal derangement. METHODS The study group involved 104 patients who had middle-ear operations, 67 of which involved harvesting of temporalis fascia and 37 that did not. The TMJs were clinically examined in each group. RESULTS The total incidence of internal derangement of the TMJ was significantly higher in the group that had temporalis fascia harvesting (79.1%), compared to the group that did not have temporalis fascia harvesting (29.7%), (p= 0.001). CONCLUSION Harvesting of temporalis fascia probably alters mandibular kinematics and predisposes to internal derangement of the TMJs.
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Affiliation(s)
- Kamal G Effat
- Department of Otolaryngology, El- Sahel Teaching Hospital, Cairo, Egypt
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5
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Sagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. An in silico investigation of the effect of bolus properties on TMJ loading during mastication. J Mech Behav Biomed Mater 2021; 124:104836. [PMID: 34544017 DOI: 10.1016/j.jmbbm.2021.104836] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
Mastication is the motor task with the highest muscle activations of the jaw region, potentially leading to high temporomandibular joint (TMJ) loading. Since increased loading of the TMJ is associated with temporomandibular disorders (TMD), TMJ mechanics during chewing has potential clinical relevance in TMD treatment. TMD self-management guidelines suggest eating soft and small pieces of food to reduce TMJ pain. Since TMJ loading cannot be measured in vivo, due to patient safety restrictions, computer modeling is an important tool for investigations of the potential connection between TMJ loading and TMD. The objective of this study is to investigate the effect of food bolus variables on mechanical TMJ loading to help inform better self-management guidelines for TMD. A combined rigid-body-finite-element model of the jaw region was used to investigate the effect of bolus size, stiffness, and position. Mandibular motion and TMJ disc von Mises stress were reported. Computed mandibular motion generally agrees well with previous literature. Disc stress was higher during the closing phase of the chewing cycle and for the non-working side disc. Smaller and softer food boluses overall lead to less TMJ loading. The results reinforce current guidelines regarding bolus modifications and provide new potential guidelines for bolus positioning that could be verified through a future clinical trial. The paper presents a first in silico investigation of dynamic chewing with detailed TMJ stress for different bolus properties. The results help to strengthen the confidence in TMD self-management recommendations, potentially reducing pain levels of patients.
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Affiliation(s)
- Benedikt Sagl
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria.
| | - Martina Schmid-Schwap
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Eva Piehslinger
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Xiaohui Rausch-Fan
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Ian Stavness
- Department of Computer Science, University of Saskatchewan, SK S7N 5C9 Saskatoon, Saskatchewan, Canada
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6
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Zumbrunn Wojczyńska A, Markova M, Ettlin DA, Gallo LM, Colombo V. In-vivo kinematic assessment of alloplastic temporomandibular joint replacements by means of helical axis: A cohort study with historical control. J Biomech 2021; 122:110494. [PMID: 33991898 DOI: 10.1016/j.jbiomech.2021.110494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022]
Abstract
Alloplastic total temporomandibular joint replacement (TJR) is a surgical procedure used to restore normal mandibular function when conservative therapies fail. The instantaneous helical axis (HA), is a mathematical model used to visualize globally rigid body kinematics. It can be applied to mandibular motion for quantification of movement patterns and irregularities. Aim of this study was to analyze HA pathways in subjects with unilateral and bilateral TJR and compare them to a control group. An optoelectronic system was employed to track mouth opening/closing cycles (n = 3) of 15 patients (7 operated unilaterally, 8 bilaterally, 11 F, aged 24-72) and 12 controls (6 F, aged 23-40). HA position in space was determined for 30 equally-distributed steps of the observed movement. Total mandibular rotation around HA (Φtot) and total translation along HA (Ttot) were determined. Angles between HA and the anatomical coordinate system of the head (θx, θy, θz); global fluctuation of HA spatial orientation (θe), distance between condylar center (CP) and HA (dCP) and its projections on the axes (xdCP, ydCP, zdCP) were calculated. Overall, Φtot was larger in controls than in bilaterally operated subjects (p = 0.002, p = 0.003) and θz was larger in unilaterally operated subjects than in controls (p = 0.004) and bilaterally operated subjects (p = 0.002, p = 0.024). During opening, θe¯ was smaller in controls than in unilaterally operated subjects (p = 0.01). The distance dCP was smaller for alloplastic joints than for controls (p < 0.01 overall). In conclusion, mandibular HA pathways in patients with TJR differ significantly from controls in terms of spatial location and variability.
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Affiliation(s)
| | - Michala Markova
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland
| | - Dominik A Ettlin
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland
| | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland
| | - Vera Colombo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Switzerland.
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7
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MRI characteristics of the asymptomatic temporomandibular joint in patients with unilateral temporomandibular joint disorder. Oral Radiol 2020; 37:469-475. [PMID: 32946019 DOI: 10.1007/s11282-020-00483-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the association between unilateral temporomandibular joint disorder (TMD) and the presence of imaging abnormalities in the contralateral, asymptomatic joint. METHODS MRI studies of 219 subjects with symptoms of unilateral TMD were examined for signs of disc displacement, osteoarthritis, disc deformation, and effusion in both temporomandibular joints (TMJ). The Chi-Square test and stepwise logistic regression analysis were performed. RESULTS Disc displacement, osteoarthritis, disc deformation, and effusion were more common on the symptomatic side. However, in the category of disc displacement with a reduction in open mouth position (DDWR), the difference was not significant between the symptomatic and the asymptomatic TMJs. Stepwise logistic regression showed that the presence of any imaging abnormality other than DDWR was related to osteoarthritis and disc deformity on the symptomatic side. On the other hand, the presence of any MRI abnormality (including DDWR) on the asymptomatic side was related only to the presence of osteoarthritis on the symptomatic side. CONCLUSIONS Unilateral symptomatic TMD is related to the presence of imaging abnormalities on the contralateral, asymptomatic side, suggesting that the development and progression of joint changes in symptomatic and contralateral asymptomatic TMJs are interrelated.
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8
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Woodford SC, Robinson DL, Mehl A, Lee PVS, Ackland DC. Measurement of normal and pathological mandibular and temporomandibular joint kinematics: A systematic review. J Biomech 2020; 111:109994. [PMID: 32971491 DOI: 10.1016/j.jbiomech.2020.109994] [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: 03/05/2020] [Revised: 07/27/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023]
Abstract
Motion of the mandible and temporomandibular joint (TMJ) plays a pivotal role in the function of the dentition and associated hard and soft tissue structures, and facilitates mastication, oral communication and access to respiratory and digestive systems. Quantification of TMJ kinematics is clinically relevant in cases of prosthetic rehabilitations, TMJ disorders, osteoarthritis, trauma, tumour resection and congenital abnormalities, which are known to directly influence mandibular motion and loading. The objective of this systematic review was to critically investigate published literature on historic and contemporary measurement modalities used to quantify in vivo mandibular and TMJ kinematics in six degrees of freedom. The electronic databases of Scopus, Web of Science, Medline, Embase and Central were searched and 109 relevant articles identified. Publication quality was documented using a modified Downs and Black checklist. Axiography and ultrasonic tracking are commonly employed in the clinical setting due to their simplicity and capacity to rapidly acquire low-fidelity mandibular motion data. Magnetic and optoelectronic tracking have been used in combination with dental splints to produce higher accuracy measurements while minimising skin motion artefact, but at the expense of setup time and cost. Four-dimensional computed tomography provides direct 3D measurement of mandibular and TMJ motion while circumventing skin motion artefact entirely, but employs ionising radiation, is restricted to low sampling frequencies, and requires time-consuming image processing. Recent advances in magnetic tracking using miniature sensors adhered to the teeth in combination with intraoral scanning may facilitate rapid and high precision mandibular kinematics measurement in the clinical setting. The findings of this review will guide selection and application of mandibular and TMJ kinematic measurement for both clinical and research applications.
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Affiliation(s)
- Sarah C Woodford
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Albert Mehl
- Centre of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
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Cattrysse E, Burioli A, Buzzatti L, Van Trijffel E. Cervical kinematics estimated by finite helical axis behaviour differs in patients with neck related problems as compared to healthy controls. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2778-2785. [DOI: 10.1007/s00586-020-06380-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/18/2020] [Accepted: 03/14/2020] [Indexed: 12/17/2022]
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10
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Olsen AM. A mobility-based classification of closed kinematic chains in biomechanics and implications for motor control. ACTA ACUST UNITED AC 2019; 222:222/21/jeb195735. [PMID: 31694932 DOI: 10.1242/jeb.195735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Closed kinematic chains (CKCs), links connected to form one or more closed loops, are used as simple models of musculoskeletal systems (e.g. the four-bar linkage). Previous applications of CKCs have primarily focused on biomechanical systems with rigid links and permanently closed chains, which results in constant mobility (the total degrees of freedom of a system). However, systems with non-rigid elements (e.g. ligaments and muscles) and that alternate between open and closed chains (e.g. standing on one foot versus two) can also be treated as CKCs with changing mobility. Given that, in general, systems that have fewer degrees of freedom are easier to control, what implications might such dynamic changes in mobility have for motor control? Here, I propose a CKC classification to explain the different ways in which mobility of musculoskeletal systems can change dynamically during behavior. This classification is based on the mobility formula, taking into account the number of loops in the CKC and the nature of the constituent joint mobilities. I apply this mobility-based classification to five biomechanical systems: the human lower limbs, the operculum-lower jaw mechanism of fishes, the upper beak rotation mechanism of birds, antagonistic muscles at the human ankle joint and the human jaw processing a food item. I discuss the implications of this classification, including that mobility itself may be dynamically manipulated to simplify motor control. The principal aim of this Commentary is to provide a framework for quantifying mobility across diverse musculoskeletal systems to evaluate its potentially key role in motor control.
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Affiliation(s)
- Aaron M Olsen
- Department of Ecology and Evolutionary Biology, Brown University, Providence, RI 02912, USA
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11
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Iriarte-Diaz J, Terhune CE, Taylor AB, Ross CF. Functional correlates of the position of the axis of rotation of the mandible during chewing in non-human primates. ZOOLOGY 2017; 124:106-118. [DOI: 10.1016/j.zool.2017.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
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12
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da Cunha DV, Degan VV, Vedovello Filho M, Bellomo DP, Silva MR, Furtado DA, Andrade AO, Milagre ST, Pereira AA. Real-time three-dimensional jaw tracking in temporomandibular disorders. J Oral Rehabil 2017; 44:580-588. [PMID: 28498502 DOI: 10.1111/joor.12521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
Abstract
When a dysfunction occurs in any component of the stomatognathic system, temporomandibular disorders (TMD) may originate. The aim of this study was to compare the deviations, displacement and the execution speed of mandibular movements among asymptomatic participants and those with TMD. Convenience sampling was used; forty participants diagnosed by clinical evaluation following the Research Diagnostic Criteria for Temporomandibular Disorders were divided into three groups: arthropathy (GART, 10 participants, 40% men), myopathy (GMYO, 10 participants, 30% men), and the control group (CG, 20 asymptomatic participants, 25% men). Participants were asked to perform the movements of free maximal mouth opening and closing, right and left lateral excursions, and protrusion with sliding teeth contacts. The mandibular trajectory was recorded using opto-electronic devices tracking reflective markers placed in front of the 'soft tissue pogonion point'. The movements were analysed on the following axis: x - medial-lateral, y - vertical, z - antero-posterior. Significative differences were found in CGxGART - unassisted maximal mouth opening and closing projection on y-axis (OCY), CGxGMYO - unassisted maximal mouth opening and closing projection on x-axis (OCX), and in the measures Opening lateral deviation on x-axis (OLDX), closing lateral deviation on x-axis (CLDX) and in the measures of speed for both. In regard to GARTxGMYO, a significative difference was found in Protrusion lateral deviation on x-axis (PLDX) 'Conover-Iman Test of Multiple Comparisons Using Rank Sums' using Bonferroni correction (P < 0·05). In conclusion, the total opening movements in individuals with TMD tended to have higher deviation than in those asymptomatic individuals and a reduction in the speed of movements.
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Affiliation(s)
- D V da Cunha
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil.,Department of Orthodontics, Faculty of Dentistry, Hermínio Ometto University, Araras, Brazil
| | - V V Degan
- Department of Orthodontics, Faculty of Dentistry, Hermínio Ometto University, Araras, Brazil
| | - M Vedovello Filho
- Department of Orthodontics, Faculty of Dentistry, Hermínio Ometto University, Araras, Brazil
| | - D P Bellomo
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - M R Silva
- Department of Occlusion, Fixed Prosthodontics and Dental Materials, Faculty of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - D A Furtado
- Faculty of Computer Science, Federal University of Uberlândia, Uberlândia, Brazil
| | - A O Andrade
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - S T Milagre
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - A A Pereira
- Laboratory of Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
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13
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Mapelli A, Machado BCZ, Garcia DM, Rodrigues Da Silva MAM, Sforza C, de Felício CM. Three-dimensional analysis of jaw kinematic alterations in patients with chronic TMD - disc displacement with reduction. J Oral Rehabil 2016; 43:824-832. [PMID: 27545052 DOI: 10.1111/joor.12424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Abstract
The study investigated whether chronic TMD patients with disc displacement with reduction (DDR), performing non-assisted maximum jaw movements, presented any changes in their mandibular kinematics with respect to an age-matched control group. Moreover, it was examined whether jaw kinematics and a valid clinic measure of oro-facial functional status have significant associations. Maximum mouth opening, mandible protrusion and bilateral laterotrusions were performed by 20 patients (18 women, 2 men; age, 18-34 years) and 20 healthy controls (17 women, 3 men; age, 20-31 years). The three-dimensional coordinates of their mandibular interincisor and condylar reference points were recorded by means of an optoelectronic motion analyser and were used to quantitatively assess their range of motion, velocity, symmetry and synchrony. Three functional indices (opening-closing, mandibular rototranslation, laterotrusion - right and left - and protrusion) were devised to summarise subject's overall performance, and their correlation with the outcome of a clinical protocol, the oro-facial myofunctional evaluation with scores (OMES), was investigated. TMD patients were able to reach maximum excursions of jaw movements comparable to healthy subjects' performances. However, their opening and closing mandibular movements were characterised by remarkable asynchrony of condylar translation. They had also reduced jaw closing velocity and asymmetric laterotrusions. The functional indices proved to well summarise the global condition of jaw kinematics, highlighting the presence of alterations in TMD-DDR patients, and were linearly correlated with the oro-facial functional status. The jaw kinematic alterations seem to reflect both oro-facial motor behaviour adaptation and a DDR-related articular impairment.
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Affiliation(s)
- A Mapelli
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - B C Z Machado
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - D M Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - M A M Rodrigues Da Silva
- Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil.,Department of Restorative Dentistry, School of Dentistry, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - C Sforza
- Functional Anatomy Research Center (FARC), Laboratory of Functional Anatomy of the Stomatognathic Apparatus, Dipartimento di Scienze Biomediche per la Salute, Faculty of Medicine, Università degli Studi di Milano, Milano, Italy
| | - C M de Felício
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. .,Craniofacial Research Support Centre, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Marková M, Gallo LM. The influence of the human TMJ eminence inclination on predicted masticatory muscle forces. Hum Mov Sci 2016; 49:132-40. [PMID: 27376178 DOI: 10.1016/j.humov.2016.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/09/2016] [Accepted: 06/23/2016] [Indexed: 12/19/2022]
Abstract
Aim of this paper was to investigate the change in masticatory muscle forces and temporomandibular joint (TMJ) reaction forces simulated by inverse dynamics when thesteepness of the anterior fossa slope was varied. We used the model by de Zee et al. (2007) created in AnyBody™. The model was equipped with 24musculotendon actuators. Mandibular movement was governed by thetrajectory of theincisal point. The TMJ was modelled as a planar constraint canted 5°medially and thecaudal inclination relative to the occlusal plane was varied from 10° to 70°. Our models showed that for the two simulated movements (empty chewing and unilateral clenching) the joint reaction forces were smallest for the eminence inclination of 30° and 40° and highest for 70°. The muscle forces were relatively insensitive to change of the eminence inclination for the angles between 20° and 50°. This did not hold for the pterygoid muscle, for which the muscle forces increased continually with increasing fossa inclination. For empty chewing the muscle force reached smaller values than for clenching. During clenching, the muscle forces changed by up to 200N.
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Affiliation(s)
- Michala Marková
- Clinic of Masticatory Disorders, Removable Prosthodontics, Geriatric and Special Care Dentistry, University of Zürich, Plattenstrasse 11, 8032 Zürich, Switzerland; Laboratory of Biomechanics, Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Technická 4, 16607 Prague 6, Czech Republic.
| | - Luigi M Gallo
- Clinic of Masticatory Disorders, Removable Prosthodontics, Geriatric and Special Care Dentistry, University of Zürich, Plattenstrasse 11, 8032 Zürich, Switzerland.
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Mandibular kinematics and masticatory muscles EMG in patients with short lasting TMD of mild-moderate severity. J Electromyogr Kinesiol 2013; 23:627-33. [DOI: 10.1016/j.jelekin.2013.01.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/27/2013] [Accepted: 01/28/2013] [Indexed: 11/21/2022] Open
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Villamil MB, Nedel LP, Freitas CMDS, Macq B. Simulation of the human TMJ behavior based on interdependent joints topology. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 105:217-232. [PMID: 22036476 DOI: 10.1016/j.cmpb.2011.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 05/16/2011] [Accepted: 09/22/2011] [Indexed: 05/31/2023]
Abstract
The temporomandibular joint (TMJ) is one of the most important and complex joints of the body and its pathologies affect a great percentage of the human population. The simulation of the TMJ behavior during opening, closing and chewing movements can be very useful to the understanding of this articulation by physicians, helping them to prevent or fix problems due to accidents or diseases. This work proposes a model to simulate the human TMJ behavior based on the concept of two interdependent joints. The model was conceived using multimodal information acquired from CT and MRI images of a live person, as well as motion data acquired from this same person with a magnetic motion capture device. Simulation of movement of other TMJs, based on different morphology of bones and teeth, is obtained by adapting the regular captured motion data through collision detection and treatment methods. The proposed model was evaluated through image registration techniques by comparing our simulated results with real, captured motion data. We also validate the model showing how it can be used to predict TMJ behavior in the presence of different--normal or abnormal--bones and teeth morphologies.
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Affiliation(s)
- Marta B Villamil
- Instituto de Informática, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Terhune CE. Modeling the biomechanics of articular eminence function in anthropoid primates. J Anat 2011; 219:551-64. [PMID: 21923720 PMCID: PMC3222834 DOI: 10.1111/j.1469-7580.2011.01424.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2011] [Indexed: 10/17/2022] Open
Abstract
One of the most prominent features of the cranial component of the temporomandibular joint (TMJ) is the articular eminence (AE). This bar of bone is the primary surface upon which the condyle translates and rotates during movements of the mandible, and is therefore the primary point at which forces are transmitted from the mandible to the cranium during loading of the masticatory apparatus. The shape of the AE is highly variable across primates, and the raised eminence of humans has often been considered a defining feature of the human TMJ, yet few data exist to address whether this variation is functionally significant. This study used a broad interspecific sample of anthropoid primates to elaborate upon and test the predictions of a previously proposed model of AE function. This model suggests that AE inclination acts to resist non-normal forces at the TMJ, thereby maximizing bite forces (BFs). AE inclination was predicted to covary with two specific features of the masticatory apparatus: height of the TMJ above the occlusal plane; and inclination of the masticatory muscles. A correlate of this model is that taxa utilizing more resistant food objects should also exhibit relatively more inclined AEs. Results of the correlation analyses found that AE inclination is strongly correlated with height of the TMJ above the occlusal plane, but less so with inclination of the masticatory muscles. Furthermore, pairwise comparisons of closely related taxa with documented dietary differences found that the AE is consistently more inclined in taxa that utilize more resistant food items. These data preliminarily suggest that variation in AE morphology across anthropoid primates is functionally related to maximizing BFs, and add to the growing dataset of masticatory morphologies linked to feeding behavior.
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Affiliation(s)
- Claire E Terhune
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.
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Terhune CE, Iriarte-Díaz J, Taylor AB, Ross CF. The Instantaneous Center of Rotation of the Mandible in Nonhuman Primates. Integr Comp Biol 2011; 51:320-32. [PMID: 21622946 DOI: 10.1093/icb/icr031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claire E Terhune
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA.
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Nickel J, Spilker R, Iwasaki L, Gonzalez Y, McCall WD, Ohrbach R, Beatty MW, Marx D. Static and dynamic mechanics of the temporomandibular joint: plowing forces, joint load and tissue stress. Orthod Craniofac Res 2009; 12:159-67. [PMID: 19627517 DOI: 10.1111/j.1601-6343.2009.01449.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- J Nickel
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
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Nickel J, Iwasaki L, Beatty M, Marx D. Tractional Forces on Porcine Temporomandibular Joint Discs. J Dent Res 2009; 88:736-40. [DOI: 10.1177/0022034509340161] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- J.C. Nickel
- University of Missouri-Kansas City, School of Dentistry, Departments of Orthodontics & Dentofacial Orthopedics and Oral Biology, 650 East 25th St., Kansas City, MO 64108-2784, USA
- University of Nebraska Medical Center -UNMC-, College of Dentistry, Departments of Adult Restorative Dentistry and Oral Biology, P.O. Box 83740, Lincoln, NE 68583-0740, USA; and
- University of Nebraska, Department of Statistics, 340 Hardin Hall North, Lincoln, NE 68583-0963, USA
| | - L.R. Iwasaki
- University of Missouri-Kansas City, School of Dentistry, Departments of Orthodontics & Dentofacial Orthopedics and Oral Biology, 650 East 25th St., Kansas City, MO 64108-2784, USA
- University of Nebraska Medical Center -UNMC-, College of Dentistry, Departments of Adult Restorative Dentistry and Oral Biology, P.O. Box 83740, Lincoln, NE 68583-0740, USA; and
- University of Nebraska, Department of Statistics, 340 Hardin Hall North, Lincoln, NE 68583-0963, USA
| | - M.W. Beatty
- University of Missouri-Kansas City, School of Dentistry, Departments of Orthodontics & Dentofacial Orthopedics and Oral Biology, 650 East 25th St., Kansas City, MO 64108-2784, USA
- University of Nebraska Medical Center -UNMC-, College of Dentistry, Departments of Adult Restorative Dentistry and Oral Biology, P.O. Box 83740, Lincoln, NE 68583-0740, USA; and
- University of Nebraska, Department of Statistics, 340 Hardin Hall North, Lincoln, NE 68583-0963, USA
| | - D.B. Marx
- University of Missouri-Kansas City, School of Dentistry, Departments of Orthodontics & Dentofacial Orthopedics and Oral Biology, 650 East 25th St., Kansas City, MO 64108-2784, USA
- University of Nebraska Medical Center -UNMC-, College of Dentistry, Departments of Adult Restorative Dentistry and Oral Biology, P.O. Box 83740, Lincoln, NE 68583-0740, USA; and
- University of Nebraska, Department of Statistics, 340 Hardin Hall North, Lincoln, NE 68583-0963, USA
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A dynamic model of jaw and hyoid biomechanics during chewing. J Biomech 2008; 41:1069-76. [PMID: 18191864 DOI: 10.1016/j.jbiomech.2007.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 11/09/2007] [Accepted: 12/01/2007] [Indexed: 11/21/2022]
Abstract
Our understanding of human jaw biomechanics has been enhanced by computational modelling, but comparatively few studies have addressed the dynamics of chewing. Consequently, ambiguities remain regarding predicted jaw-gapes and forces on the mandibular condyles. Here, we used a new platform to simulate unilateral chewing. The model, based on a previous study, included curvilinear articular guidance, a mobile hyoid apparatus, and a compressible food bolus. Muscles were represented by Hill-type actuators with drive profiles tuned to produce target jaw and hyoid movements. The cycle duration was 732 ms. At maximum gape, the lower incisor-point was 20.1mm down, 5.8mm posterior, and 2.3mm lateral to its initial, tooth-contact position. Its maximum laterodeviation to the working-side during closing was 6.1mm, at which time the bolus was struck. The hyoid's movement, completed by the end of jaw-opening, was 3.4mm upward and 1.6mm forward. The mandibular condyles moved asymmetrically. Their compressive loads were low during opening, slightly higher on the working-side at bolus-collapse, and highest bilaterally when the teeth contacted. The model's movements and the directions of its condylar forces were consistent with experimental observations, resolving seeming discordances in previous simulations. Its inclusion of hyoid dynamics is a step towards modelling mastication.
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