Modeling of the Effect of Friction in the Temporomandibular Joint on Displacement of Its Disc During Prolonged Clenching

Improved stomatognathic model for highly realistic finite element analysis of temporomandibular joint biomechanics

BACKGROUND

Mechanical response analysis of the temporomandibular joint (TMJ) is crucial for understanding the occurrence and development of diseases. However, the realistic modeling of the TMJ remains challenging because of its complex composition and multivariate associations.

OBJECTIVE

This study aims to develop a highly realistic stomatognathic model that accurately represents the geometric accuracy, structural integrity, and material properties. And further optimizes the interference and establishes the application range of the simplifications and the assumptions.

METHODS

Geometric reconstruction of the bone was based on high-resolution image data, with the accuracy of the occlusal surface ensured by plaster cast model registration. Soft tissues such as cartilage, the disc, the periodontal ligament (PDL), and disc attachments often need to be approximated or assumed. Therefore, the finite element methods (FEM) was used to optimize these assumptions, including 1) the biomechanical effects of the thickness and modulus of the PDL, 2) the approximation of the geometry and material behavior of the disc, and 3) the simplification of the loading and boundary conditions.

RESULTS

1) The deformation of the PDL causes tooth movement, which spreads to the distal condyle and further effects the TMJ load situation, 2) Disc reconstructed by MRI and hyperelastic material behavior are necessary for accurate TMJ loading analyses, 3) The loss of relative sliding movement between teeth interferes with realistic TMJ loading.

CONCLUSION

The improved stomatognathic model delivers highly realistic and validated simulation, offering theoretical guidance for virtual treatments and TMJ multivariate overload studies.

Effect of occlusal contact on TMJ loading during occlusion: An in silico study

Alterations in occlusal features may have significant consequences, ranging from dental aesthetics to health issues. Temporomandibular joint disorders (TMDs) are often associated with joint overload, and the correlation between occlusal features and TMDs has been thoroughly discussed. In current work, we introduced a novel stomatognathic model that aligns well with in vivo experimental measurements, specifically designed to decouple the impact of occlusal contact and periodontal ligament (PDL) negative feedback on temporomandibular joint (TMJ) loading. Utilizing an in-silico approach, the simulation analysis included six symmetric occlusal contact scenarios. Furthermore, a biomechanical lever model was employed to clarify the mechanical mechanism and investigate the multi-factorial effects of TMJ overload. These findings indicate that anterior shifts in the occlusal centre lead to increased TMJ loading, particularly in occlusal contact cases with anteroposterior changes. Considering the symmetrical distribution of occlusal contact, mediolateral alterations had a more modest effect on TMJ loading. Additionally, potential negative feedback activated by principal strain of periodontal could not only alleviate joint load but also diminish occlusal force. These investigations enhance our understanding of the intricate interactions between masticatory muscles, occlusal forces, and joint contact forces, thereby providing motivation for future comprehensive studies on TMJ biomechanical overload.

The challenge of ecological validity in temporomandibular disorders research

OBJECTIVE

To review the ecological validity of outcomes from current research involving temporomandibular disorders (TMDs), with an emphasis on chronic myofascial pain and the precocious development of degenerative disease of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

Current approaches used to study TMDs in terms of neuromechanics, masticatory muscle behaviours, and the dynamics of the autonomic nervous system (ANS) were assessed for ecological validity in this review. In particular, the available literature was scrutinized regarding the effects of sampling, environmental and psychophysiological constraints and averaging data across biological rhythms.

RESULTS

Validated computer-assisted numerical modelling of the neuromechanics used biological objective functions to accurately predict muscle activation patterns for jaw-loading tasks that were individual-specific. With respect to masticatory muscle behaviour, current findings refute the premise that sustained bruxing and clenching at high jaw-loading magnitudes were associated with painful TMDs such as myofascial pain. Concerning the role of the ANS in TMDs, there remains the need for personalized assessments based on biorhythms, and where the detection of dysregulated physiologic oscillators may inform interventions to relieve pain and restore normal function.

CONCLUSIONS

Future human research which focuses on TMD myofascial pain or the precocious development and progression of TMJ degenerative joint disease requires experimental designs with ecological validity that capture objectively measured data which meaningfully reflect circadian and ultradian states.

Condylar erosion is predictive of painful closed lock of the temporomandibular joint: a magnetic resonance imaging study

Background

To assess whether magnetic resonance imaging (MRI) findings of condylar erosion (CE) are predictive of a specific clinical diagnosis of painful closed lock of the temporomandibular joint (TMJ), and to determine the strength of association between CE and types of internal derangement (ID).

Methods

Based upon sample size estimation, this retrospective paired-design study involved 62 patients, aged between 18 and 67 years. Inclusion criteria were the presence of a unilateral clinical diagnosis of arthralgia coexisting with disk displacement without reduction (‘AR and DDwoR/wLO’), assigned according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I, and the absence of signs and symptoms of TMJ pain and dysfunction on the contralateral TMJ side. Bilateral sagittal and coronal MR images were obtained to establish the prevalence of CE and TMJ ID types of disk displacement with (DDR) and without reduction (DDNR). Logistic regression analysis was used to compute odds ratios for CE and ID types. Confounding variables adjusted for were age, sex, time since pain onset, pain intensity, and type of ID.

Results

In the regression analysis, the MRI items of DDR (p = 0.533) and DDNR (p = 0.204) dropped out as nonsignificant in the diagnostic clinical ‘AR and DDwoR/wLO’ group. Significant increases in the risk of ‘AR and DDwoR’ occurred with CE (3.1:1 odds ratio; p = 0.026). The presence of CE was significantly related to DDNR (adjusted OR = 43.9; p <  0.001).

Conclusions

The data suggest CE as a dominant factor in the definition of painful closed lock of the TMJ, support the view that joint locking needs to be considered as a frequent symptom of osteoarthritis, and emphasize a strong association between the MRI items of CE and DDNR.

A logistic analysis prediction model of TMJ condylar erosion in patients with TMJ arthralgia

BACKGROUND

In terms of diagnostic and therapeutic management, clinicians should adequately address the frequent aspects of temporomandibular joint (TMJ) osteoarthritis (OA) associated with disk displacement. Condylar erosion (CE) is considered an inflammatory subset of OA and is regarded as a sign of progressive OA changes potentially contributing to changes in dentofacial morphology or limited mandibular growth. The purpose of this study was to establish a risk prediction model of CE by a multivariate logistic regression analysis to predict the individual risk of CE in TMJ arthralgia. It was hypothesized that there was a closer association between CE and magnetic resonance imaging (MRI) indicators.

METHODS

This retrospective paired-design study enrolled 124 consecutive TMJ pain patients and analyzed the clinical and TMJ-related MRI data in predicting CE. TMJ pain patients were categorized according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD) Axis I protocol. Each patient underwent MRI examination of both TMJs, 1-7 days following clinical examination.

RESULTS

In the univariate analysis analyses, 9 influencing factors were related to CE, of which the following 4 as predictors determined the binary multivariate logistic regression model: missing posterior teeth (odds ratio [OR] = 1.42; P = 0.018), RDC/TMD of arthralgia coexistant with disk displacement without reduction with limited opening (DDwoR/wLO) (OR = 3.30, P = 0.007), MRI finding of disk displacement without reduction (OR = 10.96, P < 0.001), and MRI finding of bone marrow edema (OR = 11.97, P < 0.001). The model had statistical significance (chi-square = 148.239, Nagelkerke R square = 0.612, P < 0.001). Out of the TMJs, 83.9% were correctly predicted to be CE cases or Non-CE cases with a sensitivity of 81.4% and a specificity of 85.2%. The area under the receiver operating characteristic curve was 0.916.

CONCLUSION

The established prediction model using the risk factors of TMJ arthralgia may be useful for predicting the risk of CE. The data suggest MRI indicators as dominant factors in the definition of CE. Further research is needed to improve the model, and confirm the validity and reliability of the model.

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 region-dependent viscoelastic properties on the TMJ articular disc relaxation under prolonged clenching

The disc of the temporomandibular joint (TMJ) is located between the mandibular condyle and temporal bone, and has an important load-bearing and stress absorbing function. The TMJ disc presents viscoelastic characteristics that are largely dependent on its collagen fibre and proteoglycan composition and organization. The purpose of this study is to investigate the possible effects of region-specific dynamic viscoelastic properties on stress relaxation during prolonged clenching. Two finite element models were used to compare the stress distribution within the TMJ disc, namely, one with uniform disc material property and another one with region-specific disc material properties. Similar results were observed in both models with slight differences in the location of maximum stress. Larger stresses were observed in all cases for the model with uniform disc material property. Moreover, the higher values for the model with uniform disc material property appeared in the lateral region, while in the model with region-specific disc properties, these values moved to the lateral and central region. This investigation confirms that both models are sufficiently accurate to investigate stress distribution in the TMJ disc, and, particularly, the model with the region-specific disc material properties ensure better simulations of the TMJ disc behaviour.

A rat model for inducing temporomandibular anterior disc displacement experimentally

The aim of this study was to establish an experimental rat model of temporomandibular joint (TMJ) anterior disc displacement (ADD). A pilot study was conducted to determine the most appropriate surgical protocol. In the main experiment, 40 rats were used. Twenty-four rats were subjected to ADD in the right TMJ, and subsequently thereafter six, nine, and nine rats were sacrificed at 1, 4, and 8 weeks, respectively, for gross evaluation. Twelve rats that underwent a sham operation were equally divided and sacrificed at each of the above time points. Four non-treated control rats were sacrificed at the beginning of the study. TMJ blocks were harvested for radiological and histological assessment. Gross examination showed that 14 rats in the ADD group (58.3%) had anterior displacement of the TMJ disc. In the ADD joints, posterior condylar cartilage thickness decreased during the follow-up period; however, there was no significant difference between the sham-treated and ADD joints, or among the follow-up time points (P > 0.05). The anterior condylar cartilage exhibited obvious qualitative alterations. Radiologic signs of osteoarthrosis appeared after ADD surgery, but this became attenuated with time. The model investigated in this study successfully induced ADD in rats, and should be useful for assessment of progressive changes in the TMJ following ADD.

Viscoelastic properties of the central region of porcine temporomandibular joint disc in shear stress-relaxation

In this study, shear relaxation properties of the porcine temporomandibular joint (TMJ) disc are investigated. Previous studies have shown that, in fatigue failure and damage of cartilage and fibrocartilage, shear loads could be one of the biggest contributors to the failure. The aim of the present study is to develop an evaluation method to study shear properties of the disc and to do a mathematical characterization of it. For the experiments, twelve porcine discs were used. Each disc was dissected from the TMJ and, then, static strain control tests were carried out to obtain the shear relaxation modulus for the central region of the discs. From the results, it was found that the disc presents a viscoelastic behavior under shear loads. Relaxation modulus decreased with time. Shear relaxation was 10% of the instantaneous stress, which implies that the viscous properties of the disc cannot be neglected. The present results lead to a better understanding of the discs mechanical behavior under realistic TMJ working conditions.

Leptin Levels in the Synovial Fluid of Patients With Temporomandibular Disorders

PURPOSE

This study was conducted to measure concentrations of leptin and interleukin-6 (IL-6) in the synovial fluid (SF) of 38 patients with temporomandibular disorders (TMDs) and 7 healthy controls and to analyze the correlation between leptin and IL-6.

PATIENTS AND METHODS

Patients with TMDs were divided into 3 subgroups according to imaging and clinical findings: displaced disc with reduction (DDR; n = 12), displaced disc without reduction (DDNR; n = 13), and osteoarthritis (OA; n = 13). SF samples were collected, and leptin and IL-6 levels were measured by enzyme-linked immunosorbent assay.

RESULTS

No relevant difference in leptin level was found between the control group and the DDR or DDNR group, whereas the OA group presented a higher leptin concentration than all other groups. IL-6 concentrations were markedly higher in all patient groups than in the control group. Levels were markedly higher in the OA group than in the DDR or DDNR group, but no relevant differences were found between the DDR and DDNR groups. No relevant correlation was found between leptin and IL-6 concentrations.

CONCLUSION

Distinct changes in leptin and IL-6 concentrations in the SF occurred at different stages of TMDs, suggesting their potential role in the pathogenesis of TMDs.

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.

Modeling of muscle forces in humans with and without temporomandibular joint disorders

OBJECTIVES

Subjects with/without temporomandibular joint disorders (TMJD) were tested for differences in muscle forces.

SETTING AND SAMPLE POPULATION

School of Dental Medicine, University at Buffalo. Ninety-one subjects were classified in four groups based on the presence/absence (±) of chronic myofascial and/or TMJ pain (P) and bilateral disc displacement (DD).

MATERIAL AND METHODS

Validated numerical models employed an organizational objective and subjects' anatomy to calculate masticatory muscle forces during static biting. anova and Holm's step-down procedure post hoc tests assessed group differences. Theoretical geometries, representing the range of subjects' muscle orientations, were surveyed via numerical models to identify key combinations resulting in high muscle forces. Effect size (Cohen's d) and anova/post hoc tests assessed group differences in key muscle orientations.

RESULTS

+P-DD subjects had significantly higher muscle forces, especially for lateral pterygoid muscles, compared to the other groups (p<0.01) for bite forces that were directed posteromedially or posterolaterally on mandibular molars and posteriorly and slightly medially on mandibular incisors. Key muscle orientations for peak lateral pterygoid muscle forces were identified, and group comparisons showed mean orientation in +P-DD compared to other diagnostic groups was ≥5° more upright for masseter and ≥3° more posteriorly directed for temporalis muscles (all Cohen's d≥0.8).

CONCLUSION

Predicted lateral pterygoid muscle forces were significantly higher in +P-DD compared to other groups for specific biting conditions and were attributable, in part, to differences in masseter and temporalis muscle orientations.

The efficacy of a specific stabilization splint

BACKGROUND

The use of a Tanner type stabilization splint, fabricated on a leaf gauge articulation for the treatment of patients with disc displacement without reduction, is lacking in the literature.

OBJECTIVES

The purpose of the study is to collect non-controlled, therapy-related observations; in other words, to demonstrate the efficacy of this appliance for the treatment of patients with disc displacement without reduction.

METHODS

The study enrolled 55 patients, 5 men, and 50 women, with the clinical diagnosis disc displacement without reduction, 42 with and 13 without limited mouth opening. All patients received a splint in the musculoskeletally stable centric relation (CR) position. Mouth opening, clinical performance, and the timeframe of splint treatment were assessed.

RESULTS

For 37 patients with a disc displacement without reduction with limited opening, the largest increase in mouth opening (9.5 +/- 5.6 mm) occurred in the first week (7.9 +/- 2.5 days). No occlusal adjustment of the splint was needed during the treatment sequence. For three patients, treatment took up to 3 months (8.1%), for 13 patients, between 3 and 6 months (35.1%), and for 17 patients, within a year (45.9%), making a total of 89.1% successfully treated patients. Out of 50 patients, 29 had a total resolution of signs and symptoms, whereas 21 patients still suffered from solitary temporomandibular disorder (TMD) signs.

CONCLUSION

A Tanner type stabilization splint, fabricated in the musculoskeletally stable CR position, appears to be an effective and efficient means for the treatment of patients with disc displacement without reduction. Its efficacy makes it eligible to be tested in a randomized controlled trial.

CLINICAL IMPLICATIONS

The efficacy of this specific splint, fabricated in the musculoskeletally stable CR position, makes it a promising tool to treat TMD patients with disc displacement without reduction.

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.

Effect of functional shift of the mandible on lubrication of the temporomandibular joint

Lubrication of synovial joints reduces the coefficient of friction of the articular cartilage surface. To investigate the effect of malocclusion on the lubrication of the temporomandibular joint (TMJ), we evaluated lubricin expression in the rat TMJ immunohistochemically, under conditions of functional lateral shift of the mandible, during period of growth. Thirty 5-week-old male Wistar rats were divided into experimental, recovery, and control groups. Each rt in the experimental and recovery groups was fitted with an acrylic-plate guiding appliance. The rats in the experimental and control groups were killed at 14 and 28 days after the appliance was attached. Each rat in the recovery group was detached from the appliance at 14 days, and was killed 14 days after the appliance was removed. In the experimental group, the expression of lubricin staining in TMJ cartilage was significantly decreased during the experimental period. In the recovery group, the expression of lubricin staining in TMJ cartilage was significantly greater than in the experimental group, and there was no significant difference at 28 days between the control and recovery groups. Analysis of these data suggests that a functional lateral shift of the mandible during the growth period influences lubrication of the TMJ.

Biomechanical analysis of the influence of friction in jaw joint disorders

OBJECTIVE

Increased friction due to impaired lubrication in the jaw joint has been considered as one of the possible causes for internal joint disorders. A very common internal disorder in the jaw joint is an anteriorly dislocated articular disc. This is generally considered to contribute to the onset of arthritic injuries. Increase of friction as caused by impairment of lubrication is suspected to be a possible cause for such a disorder.

METHOD

The influence of friction was addressed by analysis of its effects on tensions and deformations of the cartilaginous structures in the jaw joint using computational biomechanical analysis. Jaw open-close movements were simulated while in one or two compartments of the right joint friction was applied in the articular contact. The left joint was treated as the healthy control.

RESULTS

The simulations predicted that friction primarily causes increased shear stress in the articular cartilage layers, but hardly in the articular disc.

CONCLUSIONS

This suggests that impaired lubrication may facilitate deterioration of the cartilage-subchondral bone unit of the articular surfaces. The results further suggest that increased friction is not a plausible cause for turning a normally functioning articular disc into an anteriorly dislocated one.

Current computational modelling trends in craniomandibular biomechanics and their clinical implications

Computational models of interactions in the craniomandibular apparatus are used with increasing frequency to study biomechanics in normal and abnormal masticatory systems. Methods and assumptions in these models can be difficult to assess by those unfamiliar with current practices in this field; health professionals are often faced with evaluating the appropriateness, validity and significance of models which are perhaps more familiar to the engineering community. This selective review offers a foundation for assessing the strength and implications of a craniomandibular modelling study. It explores different models used in general science and engineering and focuses on current best practices in biomechanics. The problem of validation is considered at some length, because this is not always fully realisable in living subjects. Rigid-body, finite element and combined approaches are discussed, with examples of their application to basic and clinically relevant problems. Some advanced software platforms currently available for modelling craniomandibular systems are mentioned. Recent studies of the face, masticatory muscles, tongue, craniomandibular skeleton, temporomandibular joint, dentition and dental implants are reviewed, and the significance of non-linear and non-isotropic material properties is emphasised. The unique challenges in clinical application are discussed, and the review concludes by posing some questions which one might reasonably expect to find answered in plausible modelling studies of the masticatory apparatus.

Breathing and temporomandibular joint disease

Temporomandibular joint disease (TMD) refers to a collection of pain related conditions in the masticatory muscles and temporomandibular joint. Occlusal factors have been implicated in TMD pathogenesis, yet despite decades of research no causal relationship between occlusion and TMD has been found. The significance of psychosocial factors in both the assessment and the long-term management of patients with TMD is receiving increased recognition. The teaching of relaxation skills and coping strategies are effective, proven TMD therapies. The role of breathing re-education in temporomandibular joint (TMJ) disorders is rarely mentioned. A focus on breathing patterns and their disorders potentially explains how biomechanical factors associated with psychosocial influences might lead to pathophysiological changes within the TMJ as well as in the associated muscles. Attention to factors such as breathing and postural rehabilitation provides health professionals valuable, additional tools to help care for patients with TMD.

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.