1
|
Guastaldi FPS, Matheus HR, Hadad H, Randolph MA, Redmond RW. A regenerative approach for temporomandibular joint repair: An in vitro and ex vivo study. J Oral Rehabil 2024; 51:1521-1529. [PMID: 38717007 DOI: 10.1111/joor.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/19/2024] [Accepted: 04/26/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Current clinical approaches to regenerate temporomandibular joint (TMJ) articulating cartilage defects only treat the symptoms (i.e. pain and dysfunction) and do not seek to restore joint integrity for long-term relief. Therefore, we investigated a novel self-assembling tissue-engineered cartilage to overcome this significant clinical issue for TMJ regenerative purposes. OBJECTIVES Examine the maturation of dynamic self-regenerating cartilage (dSRC) using auricular chondrocytes and evaluate a novel combinatorial approach with fractional laser treatment and dSRC implantation for TMJ cartilage repair. MATERIALS AND METHODS A suspension of 107 freshly harvested rabbit ear chondrocytes was cultured under a continuous reciprocating motion to form the dSRC. After 2, 4 and 8 weeks of culture, dSRC samples were stained with H&E, Safranin-O and Toluidine Blue. Immunohistochemistry (IHC) was performed for collagens type I and II. Channels (300-500 μm diameter and 1.2-1.5 mm depth) were created in six freshly harvested condyles using a fractional Erbium laser. Two groups were tested: dSRC in a laser-ablated lesion (experimental) and an empty laser-ablated channel (control). TMJ condyles were cultured for up to 8 weeks and analysed as described above. RESULTS H&E staining showed a high cell density in dSRC compared to native cartilage. All dSRC groups demonstrated intense Safranin-O staining, indicating high glycosaminoglycan (GAG) production and intense Toluidine Blue staining showed high proteoglycan content. IHC confirmed that dSRC consisted predominantly of collagen type II. The experimental group showed improved cartilage repair at both time points compared to the empty channels. CONCLUSION dSRC viability and successful matrix formation were demonstrated in vitro. The combination of fractional laser ablation and dSRC implantation enhanced cartilage repair.
Collapse
Affiliation(s)
- Fernando P S Guastaldi
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Henrique R Matheus
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Diagnosis and Surgery, Division of Periodontics, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Henrique Hadad
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Diagnosis and Surgery, Oral & Maxillofacial Surgery Division, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Mark A Randolph
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Redmond
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Monteiro JL, Takusagawa T, Sampaio GC, He H, de Oliveira E Silva ED, Vasconcelos BCE, McCain JP, Redmond RW, Randolph MA, Guastaldi FPS. Gelatin methacryloyl hydrogel with and without dental pulp stem cells for TMJ regeneration: An in vivo study in rabbits. J Oral Rehabil 2024; 51:394-403. [PMID: 37830126 DOI: 10.1111/joor.13608] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/21/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND In the last decade, tissue-engineering strategies for regenerating the temporomandibular joint (TMJ) have been investigated. This may be a promising strategy for the minimally invasive restoration of joint integrity. OBJECTIVES To evaluate whether dental pulp stem cells (DPSCs) loaded in a light-occured hydrogel made of gelatin methacryloyl (GelMA) enhance the regeneration of osteochondral defects in the rabbit TMJ. MATERIALS AND METHODS Defects were filled with GelMA alone (control group; n = 4) or filled with GelMA loaded with rabbit DPSCs (experimental group; n = 4), In one group, the TMJ capsule was opened without creating a defect (sham group; n = 2). The following micro-CT parameters were analysed: bone volume to total volume ratio (BV/TV%) and bone mineral density (BMD). Histological evaluation was performed to assess cartilage regeneration features. A semi-quantitative scoring system was also used to evaluate the defects. RESULTS All groups had no statistical difference regarding the micro-CT parameters. The highest mean healing score was found for the experimental group. After 4 weeks, there were no signs of hydrogel in either group or no signs of inflammation in the adjacent tissues. The tissue formed in the defect was dense fibrous connective tissue. CONCLUSION Adding DPSCs to GelMA did not provide a regenerative enhancement in TMJ osteochondral defects. This resulted in similar micro-CT parameters after 4 weeks of healing, with improved signs of subchondral bone regeneration but no cartilage regeneration.
Collapse
Affiliation(s)
- Joao Luiz Monteiro
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Oral and Maxillofacial Surgery, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Toru Takusagawa
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Gerhilde C Sampaio
- Department of Oral Medicine, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Helen He
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | | | - Belmiro C E Vasconcelos
- Department of Oral and Maxillofacial Surgery, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Joseph P McCain
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Robert W Redmond
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Randolph
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando P S Guastaldi
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Nedrelow DS, Rassi A, Ajeeb B, Jones CP, Huebner P, Ritto FG, Williams WR, Fung KM, Gildon BW, Townsend JM, Detamore MS. Regenerative Engineering of a Biphasic Patient-Fitted Temporomandibular Joint Condylar Prosthesis. Tissue Eng Part C Methods 2023; 29:307-320. [PMID: 37335050 PMCID: PMC10402699 DOI: 10.1089/ten.tec.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023] Open
Abstract
Regenerative medicine approaches to restore the mandibular condyle of the temporomandibular joint (TMJ) may fill an unmet patient need. In this study, a method to implant an acellular regenerative TMJ prosthesis was developed for orthotopic implantation in a pilot goat study. The scaffold incorporated a porous, polycaprolactone-hydroxyapatite (PCL-HAp, 20wt% HAp) 3D printed condyle with a cartilage-matrix-containing hydrogel. A series of material characterizations was used to determine the structure, fluid transport, and mechanical properties of 3D printed PCL-HAp. To promote marrow uptake for cell seeding, a scaffold pore size of 152 ± 68 μm resulted in a whole blood transport initial velocity of 3.7 ± 1.2 mm·s-1 transported to the full 1 cm height. The Young's modulus of PCL was increased by 67% with the addition of HAp, resulting in a stiffness of 269 ± 20 MPa for etched PCL-HAp. In addition, the bending modulus increased by 2.06-fold with the addition of HAp to 470 MPa for PCL-HAp. The prosthesis design with an integrated hydrogel was compared with unoperated contralateral control and no-hydrogel group in a goat model for 6 months. A guide was used to make the condylectomy cut, and the TMJ disc was preserved. MicroCT assessment of bone suggested variable tissue responses with some regions of bone growth and loss, although more loss may have been exhibited by the hydrogel group than the no-hydrogel group. A benchtop load transmission test suggested that the prosthesis was not shielding load to the underlying bone. Although variable, signs of neocartilage formation were exhibited by Alcian blue and collagen II staining on the anterior, functional surface of the condyle. Overall, this study demonstrated signs of functional TMJ restoration with an acellular prosthesis. There were apparent limitations to continuous, reproducible bone formation, and stratified zonal cartilage regeneration. Future work may refine the prosthesis design for a regenerative TMJ prosthesis amenable to clinical translation.
Collapse
Affiliation(s)
- David S. Nedrelow
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
- College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ali Rassi
- School of Industrial and Systems Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Boushra Ajeeb
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Cameron P. Jones
- College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Pedro Huebner
- School of Industrial and Systems Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Fabio G. Ritto
- Department of Oral and Maxillofacial Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Wendy R. Williams
- Division of Comparative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Bradford W. Gildon
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma College of Allied Health, Oklahoma City, Oklahoma, USA
| | - Jakob M. Townsend
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
| | - Michael S. Detamore
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, USA
| |
Collapse
|
4
|
Mélou C, Pellen-Mussi P, Jeanne S, Novella A, Tricot-Doleux S, Chauvel-Lebret D. Osteoarthritis of the Temporomandibular Joint: A Narrative Overview. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010008. [PMID: 36676632 PMCID: PMC9866170 DOI: 10.3390/medicina59010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: This study reviewed the literature to summarize the current and recent knowledge of temporomandibular joint osteoarthritis (TMJOA). Methods: Through a literature review, this work summarizes many concepts related to TMJOA. Results: Although many signaling pathways have been investigated, the etiopathogenesis of TMJOA remains unclear. Some clinical signs are suggestive of TMJOA; however, diagnosis is mainly based on radiological findings. Treatment options include noninvasive, minimally invasive, and surgical techniques. Several study models have been used in TMJOA studies because there is no gold standard model. Conclusion: More research is needed to develop curative treatments for TMJOA, which could be tested with reliable in vitro models, and to explore tissue engineering to regenerate damaged temporomandibular joints.
Collapse
Affiliation(s)
- Caroline Mélou
- CNRS, ISCR (Institut des Sciences Chimiques de Rennes), University Rennes, UMR 6226, 35000 Rennes, France
- CHU Rennes, Pôle d’Odontologie, 35033 Rennes, France
- UFR Odontologie, 35043 Rennes, France
| | - Pascal Pellen-Mussi
- CNRS, ISCR (Institut des Sciences Chimiques de Rennes), University Rennes, UMR 6226, 35000 Rennes, France
| | - Sylvie Jeanne
- CNRS, ISCR (Institut des Sciences Chimiques de Rennes), University Rennes, UMR 6226, 35000 Rennes, France
- CHU Rennes, Pôle d’Odontologie, 35033 Rennes, France
- UFR Odontologie, 35043 Rennes, France
| | - Agnès Novella
- CNRS, ISCR (Institut des Sciences Chimiques de Rennes), University Rennes, UMR 6226, 35000 Rennes, France
| | - Sylvie Tricot-Doleux
- CNRS, ISCR (Institut des Sciences Chimiques de Rennes), University Rennes, UMR 6226, 35000 Rennes, France
| | - Dominique Chauvel-Lebret
- CNRS, ISCR (Institut des Sciences Chimiques de Rennes), University Rennes, UMR 6226, 35000 Rennes, France
- CHU Rennes, Pôle d’Odontologie, 35033 Rennes, France
- UFR Odontologie, 35043 Rennes, France
- Correspondence: ; Tel.: +33-2-23-23-43-64; Fax: +33-2-23-23-43-93
| |
Collapse
|
5
|
Decellularized small intestine submucosa device for temporomandibular joint meniscus repair: Acute timepoint safety study. PLoS One 2022; 17:e0273336. [PMID: 36006938 PMCID: PMC9409591 DOI: 10.1371/journal.pone.0273336] [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: 05/23/2022] [Accepted: 08/06/2022] [Indexed: 12/02/2022] Open
Abstract
Temporomandibular joint (TMJ) Meniscus removal is an option for the patient to regain full range of motion if the disc is irreversibly damaged or unable to be reduced. However, this procedure leaves the joint vulnerable to condylar remodeling and degeneration. We have shown that extracellular matrix (ECM) scaffolds remodel into a tissue with near native TMJ meniscus in previous studies. The next step towards clinical translation is to manufacture the ECM scaffold as a device under good manufacturing practices (GMP) and test it in a pre-clinical animal study under good laboratory practices (GLP). The primary objective of this study was to evaluate the in-vivo histopathological response to a Prototype GMP manufactured device made of decellularized porcine small intestinal submucosa (SIS), by observing for signs of surrounding tissue reaction to the device that are indicative of an adverse host response in comparison to an empty control at 21 days post-surgical implantation in a canine TMJ meniscus removal and implant model in a GLP setting. The conclusive findings were that the ECM device is safe for placement in the TMJ. After 21 days post implantation, histology of tissue surrounding the device and draining lymph nodes showed that the Prototype GMP device had no negative effects compared to the empty site (as evaluated by the board-certified veterinary pathologist). Furthermore, there was a lack of negative findings for clinical pathology (hematology and clinical chemistry), mortality, and body weight/weight change. Future studies will go to one year after implantation to show that the remodel device remains as a viable tissue with near native mechanical properties.
Collapse
|
6
|
Advances in Tissue Engineering of the Temporomandibular Joint Disc: An Overview of Current Status and Future Directions. Int J Dent 2022; 2022:9696378. [PMID: 35910087 PMCID: PMC9337926 DOI: 10.1155/2022/9696378] [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: 03/18/2022] [Revised: 05/08/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Advances in tissue engineering have progressed to potentially offer a solution to temporomandibular joint disc (TMJ) disorders not amenable to conservative therapies. Conclusive treatment options for patients with end-stage disc disorders requires discectomy and reconstruction of the articular disc with various materials. Tissue engineering TMJ disc is a promising alternative to the limited and sometimes inadequate clinical options in the management of such disorders. However, tissue engineering is far from completion for the TMJ disc regeneration. This review briefly discusses the properties of native disc, the mechanism by which TMJ disorders manifest, and how a tissue engineered disc could assuage the problems inherent in the management of such disorders. Furthermore, the review addresses and provides updates to relevant themes of tissue engineering in regards to the TMJ disc, namely, the scaffolds, cells and biomarkers, hurdles in tissue engineering of the disc, and its application in translation to the clinical practice and future directions.
Collapse
|
7
|
Chen D, Wu JY, Kennedy KM, Yeager K, Bernhard JC, Ng JJ, Zimmerman BK, Robinson S, Durney KM, Shaeffer C, Vila OF, Takawira C, Gimble JM, Guo XE, Ateshian GA, Lopez MJ, Eisig SB, Vunjak-Novakovic G. Tissue engineered autologous cartilage-bone grafts for temporomandibular joint regeneration. Sci Transl Med 2021; 12:12/565/eabb6683. [PMID: 33055244 DOI: 10.1126/scitranslmed.abb6683] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Abstract
Joint disorders can be detrimental to quality of life. There is an unmet need for precise functional reconstruction of native-like cartilage and bone tissues in the craniofacial space and particularly for the temporomandibular joint (TMJ). Current surgical methods suffer from lack of precision and comorbidities and frequently involve multiple operations. Studies have sought to improve craniofacial bone grafts without addressing the cartilage, which is essential to TMJ function. For the human-sized TMJ in the Yucatan minipig model, we engineered autologous, biologically, and anatomically matched cartilage-bone grafts for repairing the ramus-condyle unit (RCU), a geometrically intricate structure subjected to complex loading forces. Using image-guided micromilling, anatomically precise scaffolds were created from decellularized bone matrix and infused with autologous adipose-derived chondrogenic and osteogenic progenitor cells. The resulting constructs were cultured in a dual perfusion bioreactor for 5 weeks before implantation. Six months after implantation, the bioengineered RCUs maintained their predefined anatomical structure and regenerated full-thickness, stratified, and mechanically robust cartilage over the underlying bone, to a greater extent than either autologous bone-only engineered grafts or acellular scaffolds. Tracking of implanted cells and parallel bioreactor studies enabled additional insights into the progression of cartilage and bone regeneration. This study demonstrates the feasibility of TMJ regeneration using anatomically precise, autologous, living cartilage-bone grafts for functional, personalized total joint replacement. Inclusion of the adjacent tissues such as soft connective tissues and the TMJ disc could further extend the functional integration of engineered RCUs with the host.
Collapse
Affiliation(s)
- David Chen
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Josephine Y Wu
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Kelsey M Kennedy
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Keith Yeager
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Jonathan C Bernhard
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Johnathan J Ng
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Brandon K Zimmerman
- Department of Mechanical Engineering, Columbia University, New York, NY 10032, USA
| | - Samuel Robinson
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Krista M Durney
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Courtney Shaeffer
- Department of Mechanical Engineering, Columbia University, New York, NY 10032, USA
| | - Olaia F Vila
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Catherine Takawira
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | | | - X Edward Guo
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Gerard A Ateshian
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA.,Department of Mechanical Engineering, Columbia University, New York, NY 10032, USA
| | - Mandi J Lopez
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Sidney B Eisig
- College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA. .,College of Dental Medicine, Columbia University, New York, NY 10032, USA.,Department of Medicine, Columbia University, New York, NY 10032, USA
| |
Collapse
|
8
|
Trindade D, Cordeiro R, José HC, Ângelo DF, Alves N, Moura C. Biological Treatments for Temporomandibular Joint Disc Disorders: Strategies in Tissue Engineering. Biomolecules 2021; 11:biom11070933. [PMID: 34201698 PMCID: PMC8301995 DOI: 10.3390/biom11070933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 01/22/2023] Open
Abstract
The temporomandibular joint (TMJ) is an important structure for the masticatory system and the pathologies associated with it affect a large part of the population and impair people's lifestyle. It comprises an articular disc, that presents low regeneration capacities and the existing clinical options for repairing it are not effective. This way, it is imperative to achieve a permanent solution to guarantee a good quality of life for people who suffer from these pathologies. Complete knowledge of the unique characteristics of the disc will make it easier to achieve a successful tissue engineering (TE) construct. Thus, the search for an effective, safe and lasting solution has already started, including materials that replace the disc, is currently growing. The search for a solution based on TE approaches, which involve regenerating the disc. The present work revises the TMJ disc characteristics and its associated diseases. The different materials used for a total disc replacement are presented, highlighting the TE area. A special focus on future trends in the field and part of the solution for the TMJ problems described in this review will involve the development of a promising engineered disc approach through the use of decellularized extracellular matrices.
Collapse
Affiliation(s)
- Daniela Trindade
- Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, 2430-028 Marinha Grande, Portugal; (D.T.); (R.C.); (D.F.Â.)
| | - Rachel Cordeiro
- Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, 2430-028 Marinha Grande, Portugal; (D.T.); (R.C.); (D.F.Â.)
| | | | - David Faustino Ângelo
- Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, 2430-028 Marinha Grande, Portugal; (D.T.); (R.C.); (D.F.Â.)
- Instituto Português da Face, 1050-227 Lisboa, Portugal;
- Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Nuno Alves
- Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, 2430-028 Marinha Grande, Portugal; (D.T.); (R.C.); (D.F.Â.)
- Correspondence: (N.A.); (C.M.); Tel.: +351-24-456-9441 (C.M.)
| | - Carla Moura
- Centre for Rapid and Sustainable Product Development, Polytechnic of Leiria, 2430-028 Marinha Grande, Portugal; (D.T.); (R.C.); (D.F.Â.)
- Correspondence: (N.A.); (C.M.); Tel.: +351-24-456-9441 (C.M.)
| |
Collapse
|
9
|
Bielajew BJ, Donahue RP, Espinosa MG, Arzi B, Wang D, Hatcher DC, Paschos NK, Wong MEK, Hu JC, Athanasiou KA. Knee orthopedics as a template for the temporomandibular joint. Cell Rep Med 2021; 2:100241. [PMID: 34095872 PMCID: PMC8149366 DOI: 10.1016/j.xcrm.2021.100241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although the knee joint and temporomandibular joint (TMJ) experience similar incidence of cartilage ailments, the knee orthopedics field has greater funding and more effective end-stage treatment options. Translational research has resulted in the development of tissue-engineered products for knee cartilage repair, but the same is not true for TMJ cartilages. Here, we examine the anatomy and pathology of the joints, compare current treatments and products for cartilage afflictions, and explore ways to accelerate the TMJ field. We examine disparities, such as a 6-fold higher article count and 2,000-fold higher total joint replacement frequency in the knee compared to the TMJ, despite similarities in osteoarthritis incidence. Using knee orthopedics as a template, basic and translational research will drive the development and implementation of clinical products for the TMJ. With more funding opportunities, training programs, and federal guidance, millions of people afflicted with TMJ disorders could benefit from novel, life-changing therapeutics.
Collapse
Affiliation(s)
- Benjamin J Bielajew
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Ryan P Donahue
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - M Gabriela Espinosa
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | | | - Nikolaos K Paschos
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark E K Wong
- Department of Oral and Maxillofacial Surgery, University of Texas School of Dentistry, Houston, TX, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| |
Collapse
|
10
|
Helgeland E, Rashad A, Campodoni E, Goksøyr Ø, Pedersen TØ, Sandri M, Rosén A, Mustafa K. Dual-crosslinked 3D printed gelatin scaffolds with potential for temporomandibular joint cartilage regeneration. Biomed Mater 2021; 16. [DOI: 10.1088/1748-605x/abe6d9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/16/2021] [Indexed: 01/16/2023]
|
11
|
Labus KM, Kuiper JP, Rawlinson J, Puttlitz CM. Mechanical characterization and viscoelastic model of the ovine temporomandibular joint Disc in indentation, uniaxial tension, and biaxial tension. J Mech Behav Biomed Mater 2020; 116:104300. [PMID: 33454627 DOI: 10.1016/j.jmbbm.2020.104300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/10/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022]
Abstract
There have been recent investigations into developing disc replacements and regenerative medicine to treat internal derangements of the temporomandibular joint (TMJ) disc. Previous attempts at disc replacements have faced challenges related in part to a limited understanding of the TMJ's complex mechanical environment. The purpose of this study was to characterize the mechanical behavior of the ovine TMJ disc and to derive viscoelastic constitutive models from the experimental data. Fresh ovine TMJ discs were tested in indentation stress-relaxation tests on the inferior surface, uniaxial tension tests to failure, and dynamic biaxial tensile tests. Results showed an order of magnitude stiffer behavior in tension in the anteroposterior (primary fiber) direction compared to the mediolateral direction. The stiffness in tension was much greater than in compression. Regional comparisons showed greater elastic moduli in indentation in the posterior and anterior bands compared to the central region. A hyper-viscoelastic constitutive model captured the dynamic stress-stretch behavior in both indentation and biaxial tension with good agreement. These data will support ongoing and future computational modeling of local TMJ mechanics, aid in biomaterials identification, and ultimately enhance development of implant designs for TMJ disc replacement.
Collapse
Affiliation(s)
- Kevin M Labus
- Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, 200 W. Lake St.Fort Collins, CO, 80523, USA
| | - Jason P Kuiper
- Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, 200 W. Lake St.Fort Collins, CO, 80523, USA
| | - Jennifer Rawlinson
- Department of Clinical Sciences, Colorado State University, 1678 Campus Delivery, 200 W. Lake St.Fort Collins, CO, 80523, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, 200 W. Lake St.Fort Collins, CO, 80523, USA; Department of Clinical Sciences, Colorado State University, 1678 Campus Delivery, 200 W. Lake St.Fort Collins, CO, 80523, USA; School of Biomedical Engineering, Colorado State University, 1376 Campus Delivery, 200 W. Lake St.Fort Collins, CO, 80523, USA.
| |
Collapse
|
12
|
Almarza AJ, Mercuri LG, Arzi B, Gallo LM, Granquist E, Kapila S, Detamore MS. Temporomandibular Joint Bioengineering Conference: Working Together Toward Improving Clinical Outcomes. J Biomech Eng 2020; 142:020801. [PMID: 31233104 DOI: 10.1115/1.4044090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 12/21/2022]
Abstract
The sixth temporomandibular joint (TMJ) Bioengineering Conference (TMJBC) was held on June 14-15 2018, in Redondo Beach, California, 12 years after the first TMJBC. Speakers gave 30 presentations and came from the United States, Europe, Asia, and Australia. The goal of the conference has remained to foster a continuing forum for bioengineers, scientists, and surgeons and veterinarians to advance technology related to TMJ disorders. These collective multidisciplinary interactions over the past decade have made large strides in moving the field of TMJ research forward. Over the past 12 years, in vivo approaches for tissue engineering have emerged, along with a wide variety of degeneration models, as well as with models occurring in nature. Furthermore, biomechanical tools have become more sensitive and new biologic interventions for disease are being developed. Clinical directives have evolved for specific diagnoses, along with patient-specific biological and immunological responses to TMJ replacement devices alloplastic and/or bioengineered devices. The sixth TMJBC heralded many opportunities for funding agencies to advance the field: (1) initiatives on TMJ that go beyond pain research, (2) more training grants focused on graduate students and fellows, (3) partnership funding with government agencies to translate TMJ solutions, and (4) the recruitment of a critical mass of TMJ experts to participate on grant review panels. The TMJ research community continues to grow and has become a pillar of dental and craniofacial research, and together we share the unified vision to ultimately improve diagnoses and treatment outcomes in patients affected by TMJ disorders.
Collapse
Affiliation(s)
- Alejandro J Almarza
- Departments of Oral Biology and Bioengineering, Center for Craniofacial Regeneration, McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Louis G Mercuri
- Visiting Professor Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612; TMJ Concepts, Ventura, CA 93003
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616
| | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich CH-8031, Switzerland
| | - Eric Granquist
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | - Sunil Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143
| | - Michael S Detamore
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, OK 73019
| |
Collapse
|
13
|
Hakim MA, Guastaldi FPS, Liapaki A, Ahn DY, Mueller ML, Troulis MJ, McCain JP. In vivo investigation of temporomandibular joint regeneration: development of a mouse model. Int J Oral Maxillofac Surg 2020; 49:940-944. [PMID: 31926823 DOI: 10.1016/j.ijom.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Abstract
Temporomandibular joint (TMJ) reconstruction is traditionally invasive. Several investigators have developed animal models, including mouse models, to study the TMJ. However, there are no detailed descriptions of a mouse model to be followed for additional research. The goal of this project was to study minimally invasive TMJ regeneration using tissue engineering in mice. As part of the project, a detailed mouse model was developed, which is described in this article. Eight carcasses were used to study the anatomy of the TMJ of the mouse and 36 mice were used to describe the surgical approach and perioperative management. The study showed similarities and differences when compared to humans. One mouse died suddenly 10 days postoperatively, while 35 mice survived the operation. Keratitis and wound dehiscence were the most common complications. Investigators reviewing this paper should be able to use this mouse model to further study TMJ regeneration in mice.
Collapse
Affiliation(s)
- M A Hakim
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA.
| | - F P S Guastaldi
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - A Liapaki
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - D Y Ahn
- David Grant USAF Medical Center, United States Air Force, Fairfield, CA, USA
| | - M-L Mueller
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - M J Troulis
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - J P McCain
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| |
Collapse
|
14
|
Patel MH, Kim RY, Aronovich S, Skouteris CA. Clinical assessment of acellular dermal matrix (AlloDerm©) as an option in the replacement of the temporomandibular joint disc: A pilot study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:496-500. [PMID: 31904524 DOI: 10.1016/j.jormas.2019.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited data available in the literature describing the utility of acellular dermal matrix (AlloDerm©) in the replacement of the temporomandibular joint disc. Few reports of clinicians using implantable AlloDerm to replace the disc do exist, however, this has been described for reconstruction after surgical resection of the entire temporomandibular joint complex to treat pathology, as opposed to isolated articular disc disorders. Moreover, there is a lack of description in the literature regarding associated perioperative outcomes after such a procedure. We sought to assess the immediate perioperative outcomes in the form of a pilot study, to determine whether this technique warrants further investigation in the form of prospective clinical studies. METHODS The study team conducted a retrospective review of medical records for patients who underwent temporomandibular joint discectomy and replacement with AlloDerm© at a single tertiary care center, from 2011 to 2016. Perioperative outcomes of interest including pain levels and range of motion were recorded and descriptive statistics were utilized for statistical analysis. RESULTS 15 patients met the inclusion criteria, of which 87% were females and 13% males. The mean age was 47.27±15.93 years. Preoperatively, 74% of the patients reported severe pain (VAS scores of 7-10); in contrast, 73% of the patients reported only mild pain (VAS scores of 1-3) during the postoperative visits, suggesting an overall reduction in pain intensity. Range of motion also improved from an average of 27.73±13.04mm, to an average of 38.60±6.08mm (P<0.01). CONCLUSIONS Based on our preliminary data, patients with advanced TMJ articular disc disorders showed clinical improvement from discectomy and replacement with acellular dermal matrix (AlloDerm©). Further longitudinal studies evaluating long-term outcomes need to be conducted to validate this technique, in the form of larger sample sizes with a control group, as well as radiographic assessment of long-term clinical outcomes.
Collapse
Affiliation(s)
- M H Patel
- University of Maryland Medical Center, Department of Oral and Maxillofacial Surgery, 22 S Greene Street, 21201 Baltimore, USA.
| | - R Y Kim
- Head and Neck Oncologic and Microvascular Reconstructive Surgery, John Peter Smith Hospital, Baylor Scott & White, Fort Worth, TX, USA
| | - S Aronovich
- University of Michigan Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - C A Skouteris
- University of Michigan Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| |
Collapse
|
15
|
Mamidi SK, Klutcharch K, Rao S, Souza JCM, Mercuri LG, Mathew MT. Advancements in temporomandibular joint total joint replacements (TMJR). Biomed Eng Lett 2019; 9:169-179. [PMID: 31168422 DOI: 10.1007/s13534-019-00105-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/23/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022] Open
Abstract
The goal of this paper is to review the advantages and disadvantages of the various treatment options of temporomandibular joint (TMJ) total joint replacement (TJR). TMJ articles published within the last 20 years were reviewed to collect the information on non-invasive and invasive TMD treatment methods. Recent technological advancements helped the evolution of treatment methods and offered significant value to TMD patients and surgeons. Considering the TMD levels, the therapeutic procedures can involve general health examiniations, physical therapy, medication, oral rehabilation or as an end stage clinical invention, temporomandibular joint replacement. In fact when intra-articular TMD is present, the effective treatment method appears to be TJR. However, concern for infection, material hypersensitivity, device longevity and screws loosening issues still exists. Further combined research utilizing the knowledge and expertise of, surgeons, material scientists, and bioengineers is needed for the development of improved TMD therapeutic treatment.
Collapse
Affiliation(s)
- Siva Kumar Mamidi
- 1Department of Biomedical Science, School of Medicine, University of Illinois College of Medicine at Rockford, Rockford, IL 61107 USA
| | - Kristin Klutcharch
- 2Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Shradha Rao
- 1Department of Biomedical Science, School of Medicine, University of Illinois College of Medicine at Rockford, Rockford, IL 61107 USA
| | - Julio C M Souza
- 3Center for MicroElectroMechanical System (CMEMS-UMINHO), Universidade do Minho, 4800-058 Guimaraes, Portugal.,Department of Dental Sciences, University Institute of Health Science (IUCS-CESPU), 4800-058 Gandra, Portugal
| | - Louis G Mercuri
- 5Present Address: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612 USA.,TMJ Concepts, Ventura, CA USA
| | - Mathew T Mathew
- 1Department of Biomedical Science, School of Medicine, University of Illinois College of Medicine at Rockford, Rockford, IL 61107 USA.,2Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612 USA
| |
Collapse
|
16
|
Donahue RP, Hu JC, Athanasiou KA. Remaining Hurdles for Tissue-Engineering the Temporomandibular Joint Disc. Trends Mol Med 2019; 25:241-256. [PMID: 30678888 PMCID: PMC6436948 DOI: 10.1016/j.molmed.2018.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 12/29/2022]
Abstract
The temporomandibular joint (TMJ) disc, a fibrocartilaginous structure between the mandible and temporal bone, is implicated in temporomandibular disorders (TMDs). TMDs symptomatically affect approximately 25% of the population, of which 70% have internal derangement of the disc. Treatments lack efficiency, motivating novel therapies, including tissue-engineering toward TMJ disc regeneration. Recent developments in scaffold-based or scaffold-free approaches, cell sources, and biochemical and mechanical stimulation have resulted in constructs exhibiting native tissue mechanics. Safety and efficacy of tissue-engineered implants have shown promising results in orthotopic animal studies. However, many hurdles need to be overcome in tissue-engineering approaches, and clinical and regulatory pathways. Future studies present an opportunity for clinicians and researchers to work together toward safe and effective clinical trials.
Collapse
Affiliation(s)
- Ryan P Donahue
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
| |
Collapse
|
17
|
Sperry MM, Kartha S, Winkelstein BA, Granquist EJ. Experimental Methods to Inform Diagnostic Approaches for Painful TMJ Osteoarthritis. J Dent Res 2019; 98:388-397. [PMID: 30819041 DOI: 10.1177/0022034519828731] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Temporomandibular joint (TMJ) osteoarthritis (OA) is a degenerative disease of the joint that can produce persistent orofacial pain as well as functional and structural changes to its bone, cartilage, and ligaments. Despite advances in the clinical utility and reliability of the Diagnostic Criteria for Temporomandibular Disorders, clinical tools inadequately predict which patients will develop chronic TMJ pain and degeneration, limiting clinical management. The challenges of managing and treating TMJ OA are due, in part, to a limited understanding of the mechanisms contributing to the development and maintenance of TMJ pain. OA is initiated by multiple factors, including injury, aging, abnormal joint mechanics, and atypical joint shape, which can produce microtrauma, remodeling of joint tissues, and synovial inflammation. TMJ microtrauma and remodeling can increase expression of cytokines, chemokines, and catabolic factors that damage synovial tissues and can activate free nerve endings in the joint. Although studies have separately investigated inflammation-driven orofacial pain, acute activity of the trigeminal nerve, or TMJ tissue degeneration and/or damage, the temporal mechanistic factors leading to chronic TMJ pain are undefined. Limited understanding of the interaction between degeneration, intra-articular chemical factors, and pain has further restricted the development of targeted, disease-modifying drugs to help patients avoid long-term pain and invasive procedures, like TMJ replacement. A range of animal models captures features of intra-articular inflammation, joint overloading, and tissue damage. Although those models traditionally measure peripheral sensitivity as a surrogate for pain, recent studies recognize the brain's role in integrating, modulating, and interpreting nociceptive inputs in the TMJ, particularly in light of psychosocial influences on TMJ pain. The articular and neural contributors to TMJ pain, imaging modalities with clinical potential to identify TMJ OA early, and future directions for clinical management of TMJ OA are reviewed in the context of evidence in the field.
Collapse
Affiliation(s)
- M M Sperry
- 1 Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - S Kartha
- 1 Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - B A Winkelstein
- 1 Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- 2 Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - E J Granquist
- 3 Oral & Maxillofacial Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
18
|
Almarza AJ, Brown BN, Arzi B, Ângelo DF, Chung W, Badylak SF, Detamore M. Preclinical Animal Models for Temporomandibular Joint Tissue Engineering. TISSUE ENGINEERING. PART B, REVIEWS 2018; 24:171-178. [PMID: 29121815 PMCID: PMC5994143 DOI: 10.1089/ten.teb.2017.0341] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/05/2017] [Indexed: 01/27/2023]
Abstract
There is a paucity of in vivo studies that investigate the safety and efficacy of temporomandibular joint (TMJ) tissue regeneration approaches, in part due to the lack of established animal models. Review of disease models for study of TMJ is presented herein with an attempt to identify relevant preclinical animal models for TMJ tissue engineering, with emphasis on the disc and condyle. Although degenerative joint disease models have been mainly performed on mice, rats, and rabbits, preclinical regeneration approaches must employ larger animal species. There remains controversy regarding the preferred choice of larger animal models between the farm pig, minipig, goat, sheep, and dog. The advantages of the pig and minipig include their well characterized anatomy, physiology, and tissue properties. The advantages of the sheep and goat are their easier surgical access, low cost per animal, and its high tissue availability. The advantage of the dog is that the joint space is confined, so migration of interpositional devices should be less likely. However, each species has limitations as well. For example, the farm pig has continuous growth until about 18 months of age, and difficult surgical access due to the zygomatic arch covering the lateral aspect of joint. The minipig is not widely available and somewhat costly. The sheep and the goat are herbivores, and their TMJs mainly function in translation. The dog is a carnivore, and the TMJ is a hinge joint that can only rotate. Although no species provides the gold standard for all preclinical TMJ tissue engineering approaches, the goat and sheep have emerged as the leading options, with the minipig as the choice when cost is less of a limitation; and with the dog and farm pig serving as acceptable alternatives. Finally, naturally occurring TMJ disorders in domestic species may be harnessed on a preclinical trial basis as a clinically relevant platform for translation.
Collapse
Affiliation(s)
- Alejandro J. Almarza
- Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan N. Brown
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Boaz Arzi
- Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
| | - David Faustino Ângelo
- Stomatology Department, Faculty of Medicine, Centro Hospitalar de Setúbal, University of Lisbon, Lisbon, Portugal
| | - William Chung
- Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen F. Badylak
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Surgery, McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Detamore
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, Oklahoma
| |
Collapse
|
19
|
Luo X, Jiang Y, Bi R, Jiang N, Zhu S. Inhibition of notch signaling pathway temporally postpones the cartilage degradation progress of temporomandibular joint arthritis in mice. J Craniomaxillofac Surg 2018; 46:1132-1138. [PMID: 29779621 DOI: 10.1016/j.jcms.2018.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/26/2018] [Accepted: 04/25/2018] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study is to explore the role of Notch signaling pathway in the initiation and progression of temporomandibular joint osteoarthritis (TMJOA). METHODS 48 mice were divided into DAPT-TMJOA, Control-TMJOA and Control-Sham groups. Animals received discectomy/Sham surgery in their right TMJ, following the DAPT/saline intra-articular injections every week. Mice were sacrificed at 1/4/8 weeks post-surgery. Safranin-O and H&E staining were performed on the TMJ sections for the modified Mankin's score. qPCR and immunohistochemistry were used to evaluate Notch1, Jagged1 and Hes5 expressions. RESULTS The mRNA expressions of Notch1, Jagged1 and Hes5 were significantly increased in Control-TMJOA group compared with Control-Sham group. Immunostaining revealed a dramatic elevation of Notch1, Jagged1 and Hes5 signals distributed in the cartilage at 1 and 4 weeks after discectomy. However, the increased number of those immuno-positive cells turned down at 8 weeks after surgery. DAPT treatment partially rescued the elevated mRNA expression and immuno-positive cell numbers of Notch1, Jagged1 and Hes5. More importantly, the cartilage destruction during TMJOA was delayed by DAPT treatment, analyzed by modified Mankin's score. CONCLUSION Notch signaling participates in the onset and development of TMJOA. Inhibiting Notch signaling activation by DAPT can partially delay the progress of TMJOA.
Collapse
Affiliation(s)
- Xueting Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yangmei Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| |
Collapse
|
20
|
Undt G, Jahl M, Pohl S, Marlovits S, Moser D, Yoon HH, Frank J, Lang S, Czerny C, Klima G, Gentleman E, Ewers R. Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:117-128. [PMID: 29653815 PMCID: PMC6057608 DOI: 10.1016/j.oooo.2018.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/07/2018] [Accepted: 02/25/2018] [Indexed: 12/13/2022]
Abstract
Objective Matrix-associated chondrocyte transplantation is routinely used in joints of the extremities but not in the temporomandibular joint (TMJ). Study Design We report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resurfacing both the mandibular condyle and the articular eminence/glenoid fossa with a commercially available collagen sponge seeded with autologous cells stabilized within a fibrin matrix. To facilitate healing, we temporarily employed a silicone membrane to protect the engineered tissues. The indications for surgery were posttraumatic fibro-osseous ankylosis, ankylosing osteoarthritis, or late-stage osteoarthritis. Results Six of the patients were recalled for follow-up after 3 years 6 months to 12 years 1 month. The maximum incisal opening was 18.2 ± 9.2 mm (range, 9-33 mm) before and 31.2 ± 13.6 mm (range, 12-47 mm) at the latest follow-up. Histologic specimens taken at 4 months showed beginning differentiation of fibrocytes into chondrocytes, whereas at 3 and 11 years, mature hyaline cartilage—not typical for the TMJ—was present. Conclusions We conclude that the reconstruction of TMJ surfaces by matrix-associated chondrocyte transplantation may become a routine method for cartilage regeneration in the TMJ in the future.
Collapse
Affiliation(s)
- Gerhard Undt
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Michael Jahl
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sebastian Pohl
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Marlovits
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris Moser
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Hyang-Hee Yoon
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jimmy Frank
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Susanna Lang
- Clinical Institute of Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Czerny
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Guenter Klima
- Clinical Institute of Pathology, Medical University of Innsbruck, Muellerstrasse 44, 6020 Innsbruck, Austria
| | - Eileen Gentleman
- Centre for Craniofacial and Regenerative Biology, King's College London, London, SE1 9RT, United Kingdom
| | - Rolf Ewers
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| |
Collapse
|
21
|
Helgeland E, Shanbhag S, Pedersen TO, Mustafa K, Rosén A. Scaffold-Based Temporomandibular Joint Tissue Regeneration in Experimental Animal Models: A Systematic Review. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:300-316. [PMID: 29400140 DOI: 10.1089/ten.teb.2017.0429] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Reconstruction of degenerated temporomandibular joint (TMJ) structures remains a clinical challenge. Tissue engineering (TE) is a promising alternative to current treatment options, where the TMJ is either left without functional components, or replaced with autogenous, allogeneic, or synthetic grafts. The objective of this systematic review was to answer the focused question: in experimental animal models, does the implantation of biomaterial scaffolds loaded with cells and/or growth factors (GFs) enhance regeneration of the discal or osteochondral TMJ tissues, compared with scaffolds alone, without cells, or GFs? Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines, electronic databases were searched for relevant controlled preclinical in vivo studies. Thirty studies reporting TMJ TE strategies in both small (rodents, rabbits; n = 25) and large animals (dogs, sheep, goats; n = 5) reporting histological and/or radiographic outcomes were included. Twelve studies reported ectopic (subcutaneous) implantation models in rodents, whereas 18 studies reported orthotopic, surgically induced defect models in large animals. On average, studies presented with an unclear-to-high risk of bias. In most studies, mesenchymal stem cells or chondrocytes were used in combination with either natural or synthetic polymer scaffolds, aiming for either TMJ disc or condyle regeneration. In summary, the overall preclinical evidence (ectopic [n = 6] and orthotopic TMJ models [n = 6]) indicate that addition of chondrogenic and/or osteogenic cells to biomaterial scaffolds enhances the potential for TMJ tissue regeneration. Standardization of animal models and quantitative outcome evaluations (biomechanical, biochemical, histomorphometric, and radiographic) in future studies, would allow more reliable comparisons and increase the validity of the results.
Collapse
Affiliation(s)
- Espen Helgeland
- 1 Department of Clinical Dentistry, Center for Clinical Dental Research, University of Bergen , Bergen, Norway
| | - Siddharth Shanbhag
- 1 Department of Clinical Dentistry, Center for Clinical Dental Research, University of Bergen , Bergen, Norway
| | - Torbjørn Ostvik Pedersen
- 1 Department of Clinical Dentistry, Center for Clinical Dental Research, University of Bergen , Bergen, Norway .,2 Department of Oral and Maxillofacial Surgery, University of Bergen and Haukeland University Hospital , Bergen, Norway
| | - Kamal Mustafa
- 1 Department of Clinical Dentistry, Center for Clinical Dental Research, University of Bergen , Bergen, Norway
| | - Annika Rosén
- 1 Department of Clinical Dentistry, Center for Clinical Dental Research, University of Bergen , Bergen, Norway .,2 Department of Oral and Maxillofacial Surgery, University of Bergen and Haukeland University Hospital , Bergen, Norway
| |
Collapse
|
22
|
|