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Wadhwa S, Skelton M, Fernandez E, Paek T, Levit M, Yin MT. Significance of radiographic temporomandibular degenerative joint disease findings. Semin Orthod 2024; 30:277-282. [PMID: 38983798 PMCID: PMC11230652 DOI: 10.1053/j.sodo.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
The field of orthodontics has seen a recent increase in the number of patients over the age of 50 seeking treatment and also an increase in the use of cone beam technology. Similar to other joints in the body, the temporomandibular joint (TMJ) is associated with age-related degeneration. However, unlike other joints, degeneration of the TMJ is rarely symptomatic and when there is pain, it is usually self-limiting. In this article, we will review: a) the incidence and prevalence of TMJ degenerative diseases, b) similarities and differences of TMJ vs knee degenerative diseases, and c) current treatment recommendations for TMJ degenerative diseases. In the vast majority of people, radiographic evidence of TMJ degeneration is an incidental finding. Future longitudinal research is needed to follow the natural course of TMJ degenerative patients.
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Affiliation(s)
- Sunil Wadhwa
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Michelle Skelton
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Emily Fernandez
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Taylor Paek
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Michael Levit
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Michael T Yin
- Columbia University College of Physicians and Surgeons, Division of Infectious Diseases, NYC, NY, USA 10032
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Min CK, Kim KA, Lee KE, Suh BJ, Jung W. A study on volumetric change of mandibular condyles with osteoarthritis using cone-beam computed tomography. Sci Rep 2024; 14:10232. [PMID: 38702404 PMCID: PMC11068749 DOI: 10.1038/s41598-024-60404-z] [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: 11/02/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
This study aimed to quantitatively assess three-dimensional changes in the mandibular condyle with osteoarthritis using cone-beam computed tomography (CBCT). Pre- and post-treatment CBCT images of temporomandibular joints (TMJs) from 66 patients were used to assess longitudinal changes in condylar volume within individual patients using 3D slicer software. Total volume difference (dV), net increase (dV + , bone deposition), and net decrease (dV- , bone resorption) after treatment were analyzed based on clinical and radiological factors. Condyles with surface erosion at their first visit showed significantly decreased volume after treatment compared to condyles without erosion (p < 0.05). Amounts of bone resorption and deposition were higher in condyles with surface erosion (both p < 0.01). In patients with condylar erosion, the presence of joint pain was associated with a decrease in condylar volume and an increase in net resorption (both p < 0.01). When both joint pain and condylar erosion were present, patients with parafunctional habits showed reduced condylar volume after treatment (p < 0.05). Condylar volume change after treatment was negatively correlated with the duration of pain relief (R = - 0.501, p < 0.05). These results indicate that condylar erosion and TMJ pain could be significant variables affecting TMJ volume changes after treatment. Establishing appropriate treatment strategies is crucial for managing condylar erosion and TMJ pain.
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Affiliation(s)
- Chang-Ki Min
- Department of Oral and Maxillofacial Radiology, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Kyoung-A Kim
- Department of Oral and Maxillofacial Radiology, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Kyung-Eun Lee
- Department of Oral Medicine, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Bong-Jik Suh
- Department of Oral Medicine, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Won Jung
- Department of Oral Medicine, Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University, Jeonju, South Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
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Musa M, Awad R, Izeldin S, Zhao Y, Wu H, Wang L, Al-Hadad SA, Saif BS, Ahmed MMS, Chen X. Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders with and without skeletal lateral mandibular asymmetry: a cone beam computed tomographic study. BMC Oral Health 2024; 24:363. [PMID: 38515064 PMCID: PMC10956259 DOI: 10.1186/s12903-024-04119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Temporomandibular disorders (TMDs) encompass pain and dysfunction in the jaw, muscles, and adjacent structures. This study aimed to explore the quantitative (condylar position, morphology) and qualitative (bone mineral density (BMD)) therapeutic outcomes following a stabilization splint (S.S.) therapy in adult patients diagnosed with TMD (Arthralgia) with/without lateral mandibular asymmetry (MA) using cone beam computed tomography (CBCT). METHODS In this retrospective clinical study, 60 adult TMD patients who received S.S. therapy were enrolled and allocated into the TMD group (TMDG) and TMD with MA group (TMD + MAG). The diagnosis was made according to the Diagnostic Criteria for TMD (DC/TMD) AXIS I. MA was measured from the mid-sagittal plane to the Menton point. CBCT was used to scan the temporomandibular joints pre- (T0) and post- (T1)-treatment for three-dimensional analysis. Intra- and intergroup statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal‒Wallis test. RESULTS For quantitative comparisons, there was a statistically significant difference between T0 and T1 in the joint spaces of TMD + MAG (anterior, superior, posterior, and coronal lateral on the deviated side as well as in the superior, coronal medial joint space of the contralateral side). Morphologically, the deviated side had a narrower condylar width, reduced condylar height, and a steeper eminence angle. In contrast, the contralateral side tended to have a greater condylar length. For qualitative measurements, BMD also showed statistical significance between T0 and T1 in the majority of the condyle slopes (AS, SS, PS, and LS on the deviated side and in AS and MS on the contralateral side) of TMD + MAG. Additionally, only the AS and PS showed significance in TMDG. CONCLUSION Multiple joint space widening (AJS and CMS) and narrowing (SJS, PJS, and CLS) could characterize the deviated side in TMD + MA. Factors like narrower condylar width, reduced condylar height, and steeper eminence angle on the deviated side can worsen TMD + MA. Proper alignment of the condyle-disc position is essential for optimal function and load distribution, potentially affecting bone mineral density (BMD). MA plays a prominent role in disturbing bone densities. S.S. therapy shows more evident outcomes in TMD + MAG (on the deviated side compared to the contralateral side) than the TMDG.
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Affiliation(s)
- Mazen Musa
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
- Department of Orthodontics, Al Tegana Dental Teaching Hospital, Faculty of Dentistry, University of Science and Technology Omdurman, Khartoum, Sudan
| | - Riham Awad
- Department of Pediatrics Dentistry, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
- Department of Pediatrics Dentistry, Faculty of Dentistry, International University of Africa, Khartoum, Sudan
| | - Salma Izeldin
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
- Department of Orthodontics, Faculty of Dentistry, Karary University, Omdurman, Khartoum, Sudan
| | - Yunshan Zhao
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Hao Wu
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Lu Wang
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Saba Ahmed Al-Hadad
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
- Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
| | - Bdr Sultan Saif
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Madiha Mohammed Saleh Ahmed
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
- Department of Orthodontics, Faculty of Dentistry, Aden University, Aden, Republic of Yemen
| | - Xi Chen
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China.
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Ding WH, Li YF, Liu W, Li W, Wu N, Hu SY, Shi JJ. Effect of occlusal stabilisation splint with or without arthroscopic disc repositioning on condylar bone remodelling in adolescent patients. Int J Oral Maxillofac Surg 2024; 53:156-164. [PMID: 37357072 DOI: 10.1016/j.ijom.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
The aim of this study was to investigate the treatment effects of a stabilisation splint (SS) with and without arthroscopic disc repositioning (ADR) on condylar bone remodelling in adolescent patients with anterior disc displacement without reduction (ADDwoR). Cone beam computed tomography and magnetic resonance imaging were used to analyse condylar bone remodelling, condyle position, and disc position. Twenty-two temporomandibular joints of 14 patients who underwent ADR (age range 12-20 years; mean follow-up 12.5 ± 7.8 months) and 21 temporomandibular joints of 14 patients who did not undergo ADR (age range 13-20 years; mean follow-up 11.1 ± 5.1 months) were included. The change in bone volume (P < 0.001), rate of bone volume change (P < 0.001), and change in condyle height (P = 0.031) were significantly greater in patients with ADR than in those without ADR. The changes in posterior joint space (P = 0.013), superior joint space (P = 0.020), and ratio of condyle sagittal position (P = 0.013) were significantly greater in patients with ADR than in those without ADR. All discs in patients who underwent ADR and one disc in those who did not undergo ADR were backward repositioned. In conclusion, in adolescent patients with ADDwoR, ADR with SS therapy achieved better condyle and disc position than SS therapy alone, and also induced bone generation.
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Affiliation(s)
- W H Ding
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Y F Li
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - W Liu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - W Li
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - N Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - S Y Hu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - J J Shi
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China.
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Schadow JE, Maxey D, Smith TO, Finnilä MAJ, Manske SL, Segal NA, Wong AKO, Davey RA, Turmezei T, Stok KS. Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis. Bone 2024; 178:116948. [PMID: 37926204 DOI: 10.1016/j.bone.2023.116948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards. DESIGN A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis. RESULTS This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties. CONCLUSIONS Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.
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Affiliation(s)
- Jemima E Schadow
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
| | - David Maxey
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
| | - Toby O Smith
- Warwick Medical School, University of Warwick, United Kingdom.
| | - Mikko A J Finnilä
- Research Unit of Health Science and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Sarah L Manske
- Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, United States.
| | - Andy Kin On Wong
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Schroeder's Arthritis Institute, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
| | - Rachel A Davey
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
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Feng JL, Ma RH, Sun LL, Zhao JR, Zhao YP, Li G. Quantitative assessment of condylar bone resorption using fused CBCT images: differentiating and diagnosing three distinct groups based on volume and thickness decrease. Dentomaxillofac Radiol 2023; 52:20230337. [PMID: 37870149 DOI: 10.1259/dmfr.20230337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVES To investigate the accuracy of fused CBCT images in diagnosing three distinct groups of bone changes characterized by volume and thickness decrease in patients with temporomandibular joint osteoarthrosis (TMJ OA) during follow-up. METHODS In this retrospective study, 109 patients (176 TMJs) with TMJ OA were included. Two consecutive CBCT images for the same patient were registered and fused. Then, three image sets were established: without fusion, fused 2D image, and fused 3D image. Three residents randomly and independently evaluated whether there was condylar resorption with the three image sets respectively. The samples diagnosed as condylar resorption by the expert panel were divided into three subgroups according to the volume and thickness decrease calculated after segmentation. The inter- and intraobserver agreement, receiver operating characteristic (ROC), and area under the curve (AUC) evaluated the diagnostic capability for different subgroups. RESULTS For the volume decrease more than 50 mm3 and thickness decrease more than 1 mm groups, the AUC values for fused image sets were higher than those without fusion (p < 0.01). For the volume decrease within 50 mm3 and thickness decrease within 1 mm groups, the AUC values for fused 2D image sets were higher than the image sets without fusion (p < 0.05), but there was no significant difference between the fused 3D image sets and the image sets without fusion (p = 0.48 for volume decrease, p = 0.37 for thickness decrease). CONCLUSIONS The fused images can improve the diagnostic accuracy and repeatability for the samples with at least 50 mm3 volume decrease or 1 mm thickness decrease compared with the image groups without fusion.
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Affiliation(s)
- Ji-Ling Feng
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Device & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Ruo-Han Ma
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Device & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Li-Li Sun
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Device & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Jun-Ru Zhao
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Device & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Yan-Ping Zhao
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Device & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
- Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gang Li
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Device & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
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Ju HM, Kim HW, Choi SY, Jeon HM, Jeong SH, Ahn YW, Ok SM. A Comparison of the Condyle and Articular Eminence in Asian Juvenile Idiopathic Osteoarthritis Patients with Unilateral and Bilateral TMJ Involvement: A Retrospective Case-Control Study. J Clin Med 2023; 12:5566. [PMID: 37685631 PMCID: PMC10489145 DOI: 10.3390/jcm12175566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
This study compared the condylar volume, length, and articular eminence (AE) characteristics of normal individuals to those with unilateral and bilateral juvenile idiopathic osteoarthritis (JOA). The 116 patients were divided into four groups: Control (n = 16), affected condyle of unilateral JOA (Aff-Uni) (n = 36), non-affected condyle of JOA (NonAff-uni) (n = 36), and bilateral JOA (Bilateral) (n = 28). The differences in condyle volume and length and AE were analyzed using ANOVA and Bonferroni post-hoc tests. The results showed that Bilateral had a significantly different condylar volume, especially in the condylar head (p < 0.01), specifically the middle, anterior, and medial parts (p < 0.05). Condylar length also differed among the groups, with differences observed between the control group and the other three groups, as well as between the bilateral group and the other three groups (p < 0.01). AE total volume differed between the control group and Aff-Uni. In the detailed comparison, Aff-Uni and NonAff-Uni were smaller than the control group in the posterior, lateral, and medial sections (p < 0.05). In conclusion, depending on the involvement of unilateral or bilateral JOA, there were differences in condylar volume and AE when compared to the normal control group. Therefore, a prognosis should be evaluated by distinguishing between patients with unilateral and bilateral JOA.
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Affiliation(s)
- Hye-Min Ju
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
| | - Hee-Won Kim
- Department of Oral Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan-si 50612, Republic of Korea; (H.-W.K.); (S.-Y.C.)
| | - Seo-Young Choi
- Department of Oral Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan-si 50612, Republic of Korea; (H.-W.K.); (S.-Y.C.)
| | - Hye-Mi Jeon
- Dental Clinic Center, Pusan National University Hospital, Busan 49241, Republic of Korea;
| | - Sung-Hee Jeong
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
| | - Yong-Woo Ahn
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
| | - Soo-Min Ok
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
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8
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Musa M, Zhang Q, Awad R, Wang W, Ahmed MMS, Zhao Y, Almashraqi AA, Chen X, Alhammadi MS. Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders. Clin Oral Investig 2023; 27:2299-2310. [PMID: 37039959 DOI: 10.1007/s00784-023-04963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/19/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE This study aimed to explore the quantitative and qualitative condylar changes following stabilization splint (S.S) therapy, including condylar position, morphology, and bone mineral density (BMD) in subjects with temporomandibular disorders (TMD). MATERIALS AND METHODS In this retrospective clinical study, we enrolled 40 TMD subjects (80 joints) aged 18 to 35 years, for whom a S.S was used to treat TMD. The 80 TMD consists of 32 masticatory muscle disorders (myalgia) and 48 TMJ disorders (arthralgia). Cone beam computed tomography (CBCT) was used to scan the TMJs of subjects pre- and post-treatment for three-dimensional analysis (3D). Using Mimics software v.21.0, quantitative (3D condylar and joint spaces dimensions parameters were measured using linear measurements in millimeters, according to the Kamelchuk method and Ikeda method, while the assessment of anteroposterior condyle position within the glenoid fossa was based on the method of Pullinger and Hollender), and qualitative (a round bone tissue with an area of 2 mm2 in three representative areas according to the Kamelchuk method to measure condylar BMD) pre- and post-treatment. Intra- and inter-group statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal-Wallis test, respectively. RESULTS The course of treatment was 6-12 months, with an average of 9.1 months. For the pre- and post-treatment quantitative comparisons, there was a statistically significant difference in the anterior joint space (AJS) and coronal medial space, as well as the condyle length in the myalgia group and condylar width in the arthralgia group. For qualitative measurements, a significant difference was observed in the posterior slope of the myalgia group and the arthralgia group's anterior, superior, and posterior slopes. The inter-group comparisons revealed significant differences in AJS, condylar length, and anterior slope density. CONCLUSION In short-term follow-up, the S.S influenced patients with TMD from different origins; it changes anterior and coronal medial joint space, condyle length in myalgia, and width in arthralgia. Furthermore, it improved the condyle bone density more evidently in arthralgia. CLINICAL RELEVANCE This study highlights the influence of S.S on symptomatic populations with TMD of different origins from a qualitative and quantitative perspective.
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Affiliation(s)
- Mazen Musa
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
- Department of Orthodontics, Al Tagana Dental Teaching Hospital, Faculty of Dentistry, University of Science and Technology Omdurman, Omdurman, 11111, Khartoum, Sudan
| | - Qianqian Zhang
- Department of Stomatology, Shaan'xi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Riham Awad
- Department of Pediatrics Dentistry, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Wenfang Wang
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Madiha Mohammed Saleh Ahmed
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
- Department of Orthodontics, Faculty of Dentistry, Aden University, Aden, Yemen
| | - Yunshan Zhao
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Abeer A Almashraqi
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - Xi Chen
- Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Maged S Alhammadi
- Orthodontics and Dentofacial Orthopedics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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9
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Feng JL, Ma RH, Du H, Zhao YP, Meng JH, Li G. Diagnostic accuracy of fused CBCT images in the evaluation of temporomandibular joint condylar bone resorption. Clin Oral Investig 2023; 27:1277-1288. [PMID: 36303076 DOI: 10.1007/s00784-022-04761-x] [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: 06/28/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of fused CBCT images for patients with condylar bone resorption of temporomandibular joint (TMJ) osteoarthrosis. MATERIALS AND METHODS Forty-two TMJs from twenty-one patients were included. Bone resorption of condyles evaluated by three experts was used as the reference standard. Three oral and maxillofacial radiology residents evaluated the resorption of condyles with a five-point scale for the four sets of images (two consecutive CBCT images without fusion, fused 2D cross-sectional images, fused 3D images, and combining fused 2D cross-sectional images and fused 3D images) randomly and independently. Each set of images was evaluated at least 1 week apart, and a second evaluation was performed 4 weeks later. Intraclass correlation coefficients were calculated to assess the intra- and inter-observer agreement. The areas under the ROC curves (AUCs) were compared among the four image sets using the Z test. RESULTS Twenty-four TMJs were determined as condylar bone resorption, and eighteen were determined as no obvious change. The average AUC values from the three observers for the three fused image sets (0.94, 0.93, 0.93) were significantly higher than the image set without fusion (p < 0.01). The intra- and inter-observer agreement on the three fused image sets (0.70-0.89, 0.91-0.92) was higher than the image set without fusion (0.37-0.63, 0.75). CONCLUSIONS Fused CBCT images of TMJ osteoarthrosis patients can intuitively display the condylar bone resorption and significantly improve the diagnostic accuracy. CLINICAL RELEVANCE Fused CBCT images can help clinicians intuitively observe bone changes of the condyle in TMJ osteoarthrosis patients.
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Affiliation(s)
- Ji-Ling Feng
- Department of Oral and Maxillofacial Radiology, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Ruo-Han Ma
- Department of Oral and Maxillofacial Radiology, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Han Du
- Department of Oral and Maxillofacial Radiology, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.,Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yan-Ping Zhao
- Department of Oral and Maxillofacial Radiology, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.,Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China
| | - Juan-Hong Meng
- Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gang Li
- Department of Oral and Maxillofacial Radiology, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
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10
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Qin X, He Y, Zhang S, Jin N, Yang Z. Comparison of two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease. Angle Orthod 2023; 93:49-56. [PMID: 36223213 PMCID: PMC9797142 DOI: 10.2319/042822-321.1] [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: 04/01/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To compare two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease. MATERIALS AND METHODS A total of 47 patients were included in this study. Group anterior repositioning splint (ARS) was treated with temporomandibular joint (TMJ) disc surgery followed by an ARS and camouflage orthodontic treatment. Group stabilization splint (SS) was treated with an SS followed by orthodontic treatment combined with orthognathic surgery. Cephalometric analysis of lateral radiographs and measurements of condylar height were evaluated before and after splints. RESULTS In group ARS, mandibular advancement was observed after treatment in 21 of 24 patients (87.5%). The SNB angle increased by an average of 1.40 ± 1.01°. The ANB angle, overjet, Wits, and convexity decreased. Facial angle and soft tissue N Vert to pogonion increased. Vertically, MP-FH, MP-SN, y-axis, and vertical ratio decreased and ANS-Me/N-Me and S-Go/N-Me increased, suggesting a counterclockwise rotation of the mandible. In group SS, 18 of 23 patients (78.3%) showed a backward change tendency. The SNB angle reduced by 0.90 ± 0.93°. The ANB angle, overjet, Wits, convexity, and y-axis increased. The facial angle and soft tissue N Vert to soft tissue pogonion (ST N Vert to ST pogonion) decreased. Magnetic resonance imaging showed condylar height increased by 1.45 ± 3.05 mm (P = .002) in group ARS. In group SS, condylar height change was not consistent. CONCLUSIONS TMJ disc surgery followed by ARS promoted condylar bone remodeling and regeneration. The SNB angle increased, and the severity of skeletal Class II was improved. The SS enabled the mandible to withdraw backward and revealed a retrognathic but true mandible position.
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11
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Assessment of Morphologic Change of Mandibular Condyle in Temporomandibular Joint Osteoarthritis Patients with Stabilization Splint Therapy: A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10101939. [PMID: 36292386 PMCID: PMC9601680 DOI: 10.3390/healthcare10101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: The purpose of this study was to evaluate the 3-dimensional bony changes of the mandibular condyle in temporomandibular joints-osteoarthritis (TMJ-OA) patients treated with stabilization splint (SS) therapy using shape correspondence analysis. (2) Methods: A total of 27 adult patients (2 men and 25 women) with a mean age of 24.6 ± 3.9 years were included in this study. All patients were diagnosed with TMJ-OA and were treated with an SS. Cone-beam computed tomography data of the condylar head before and after SS therapy from 42 condyles (15 bilateral and 12 unilateral TMJ-OA) were used for the analysis. For the performance shape correspondence analysis (SPHARM-PDM), statistical differences were performed using the one-way analysis of variance and Scheffe post hoc tests. (3) Results: After SS treatment in TMJ-OA patients, bone resorption of the condyle head surface was predominant in the anterosuperior, superolateral, and superior areas, and bone formation was superior in the lateral, medial, posterosuperior, and posteromedial areas. The change in the condylar volume between the two groups was not statistically significant. (4) Conclusions: After SS treatment in TMJ-OA patients, there was both bone resorption and bone formation on the mandibular condyle head surface, which induced morphological changes in the condyle head.
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12
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Lan KW, Chen JM, Jiang LL, Feng YF, Yan Y. Treatment of condylar osteophyte in temporomandibular joint osteoarthritis with muscle balance occlusal splint and long-term follow-up: A case report. World J Clin Cases 2022; 10:4264-4272. [PMID: 35665098 PMCID: PMC9131237 DOI: 10.12998/wjcc.v10.i13.4264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/16/2021] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Condylar osteophytes, a remodeling form of temporomandibular joint osteoarthritis (TMJ OA), mainly manifest as marginal angular outgrowths of the condyle. Previous researchers have advocated surgical removal of condylar osteophytes. Reports on the effect of occlusal splint on TMJ OA patients’ joints have mostly focused on treatment with this splint, which can reduce the absorption of the affected condyle and promote repair and regeneration. However, the effect of the splint on the dissolution of condylar osteophytes has not yet been reported.
CASE SUMMARY A 68-year-old female patient suffered from occlusal discomfort with left facial pain for 2 years. Cone beam computed tomography showed a rare osteophyte on top of her left condyle. She was finally diagnosed with TMJ OA. The patient refused surgical treatment and received conservative treatment with a muscle balance occlusal splint. The pain experienced by the patient on the left side of her face was relieved, and her chewing ability recovered after treatment. The osteophyte dissolved, and the condylar cortex remained stable during long-term follow-up observations.
CONCLUSION The muscle balance occlusal splint could be a noninvasive means of treating condylar osteophytes in TMJ OA patients.
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Affiliation(s)
- Kai-Wen Lan
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou 510080, Guangdong Province, China
| | - Jia-Min Chen
- Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou 510182, Guangdong Province, China
| | - Liu-Lin Jiang
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou 510080, Guangdong Province, China
| | - Yi-Fan Feng
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou 510080, Guangdong Province, China
| | - Ying Yan
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou 510080, Guangdong Province, China
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13
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Jung W, Lee KE, Suh BJ. Comparison of Clinical and Radiological Characteristics of Temporomandibular Joint Osteoarthritis in Older and Young people. Open Dent J 2022. [DOI: 10.2174/18742106-v15-e2112290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives:
The relatively high prevalence of temporomandibular joint (TMJ) osteoarthritis (OA) in older people increases the necessity to investigate the specific characteristics of TMJ-OA in this particular population. This study aimed to analyze the longitudinal changes in clinical and radiological characteristics of TMJ-OA in older people.
Methods:
We retrospectively analyzed the clinical features and cone-beam computed tomography (CBCT) images of 76 participants with TMJ-OA. Participants were classified into two groups according to age. The older people group included 33 participants over 50 years of age, and the control group included 43 participants in their 15-29 years. We analyzed the differences in clinical features and the distribution of destructive bony changes on CBCT images between groups.
Results:
The duration of pain was significantly shorter in the older people group (P = .046); however, the treatment duration was significantly longer in the older people group (P = .001). There was a significant difference in the distribution of destructive bony features between groups (P = .005). In the older people group, “three or more features” (36.3%) were the most common, whereas in the control group, “erosion” (44.2%) was the most common. After treatment, there was little improvement in the frequency of “erosion” in the older people group. There was a significant difference in the proportion of erosion after treatment between the groups (P = .033).
Conclusion:
In older people with TMJ-OA, active treatment to effectively induce condylar remodeling should be considered.
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14
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Jung W, Lee KE, Suh BJ. Comparison of Clinical and Radiological Characteristics of Temporomandibular Joint Osteoarthritis in Older and Young people. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2112290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives:
The relatively high prevalence of temporomandibular joint (TMJ) osteoarthritis (OA) in older people increases the necessity to investigate the specific characteristics of TMJ-OA in this particular population. This study aimed to analyze the longitudinal changes in clinical and radiological characteristics of TMJ-OA in older people.
Methods:
We retrospectively analyzed the clinical features and cone-beam computed tomography (CBCT) images of 76 participants with TMJ-OA. Participants were classified into two groups according to age. The older people group included 33 participants over 50 years of age, and the control group included 43 participants in their 15-29 years. We analyzed the differences in clinical features and the distribution of destructive bony changes on CBCT images between groups.
Results:
The duration of pain was significantly shorter in the older people group (P = .046); however, the treatment duration was significantly longer in the older people group (P = .001). There was a significant difference in the distribution of destructive bony features between groups (P = .005). In the older people group, “three or more features” (36.3%) were the most common, whereas in the control group, “erosion” (44.2%) was the most common. After treatment, there was little improvement in the frequency of “erosion” in the older people group. There was a significant difference in the proportion of erosion after treatment between the groups (P = .033).
Conclusion:
In older people with TMJ-OA, active treatment to effectively induce condylar remodeling should be considered.
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15
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Yap AU, Zhang XH, Cao Y, Fu KY. Functional, physical and psychosocial impact of degenerative temporomandibular joint disease. J Oral Rehabil 2021; 49:301-308. [PMID: 34862971 DOI: 10.1111/joor.13288] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/28/2021] [Accepted: 11/26/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study evaluated the functional, physical and psychosocial impacts of TMJ degenerative joint disease (DJD). The bearing of TMJ osteoarthrosis/osteoarthritis and early/late TMJ DJD on oral health-related quality of life (OHRQoL) were also compared. METHODS Participants were enrolled from a TMD/oro-facial pain centre. Those diagnosed with intra-articular conditions based on the Diagnostic Criteria for Temporomandibular disorders (DC/TMD) were subjected to CBCT assessment and categorised into four discrete groups: NN-no TMJ DJD and no arthralgia; NA-no TMJ DJD with arthralgia; TO-TMJ osteoarthrosis; and TR-TMJ osteoarthritis. The TO/TR groups were subdivided into early/late TMJ osteoarthrosis (EO/LO) and osteoarthritis (ER/LR). OHRQoL was examined using the OHIP-TMD, and data were appraised with the Kruskal-Wallis/Mann-Whitney U tests (α = 0.05). RESULTS The study participant (n = 358) had a mean age of 31.85 ± 12.39 years (85.6% women). Frequencies of the TMD groups were as follows: NN-23.2%; NA-27.1%; TO-19.0%; and TR-30.7%. Participants with TR/NA had significantly worse OHRQoL than those with TO/NN. Additionally, participants with ER/LR reported significantly poorer OHRQoL than their counterparts with EO/LO. For all TMD groups and TMJ DJD subgroups, the psychological discomfort domain was generally the most impaired. Differences in global OHIP scores were significant between participants with and without arthralgia (i.e., NA-NN, ER-EO and LR-LO). CONCLUSIONS The presence of TMJ pain appeared to impair OHRQoL more than the severity of TMJ DJD. As psychological domains were most impacted, psychosocial care should be incorporated when managing patients with painful TMJ DJD.
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Affiliation(s)
- Adrian Ujin Yap
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore City, Singapore.,National Dental Centre Singapore and Duke-NUS Medical School, National Dental Research Institute Singapore, Singapore Health Services, Singapore City, Singapore
| | - Xiao-Han Zhang
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Center of Stomatology & National Clincial Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ye Cao
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Center of Stomatology & National Clincial Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Kai-Yuan Fu
- Centre for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Center of Stomatology & National Clincial Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
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16
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Han K, Kim MC, Kim YJ, Song Y, Tae I, Ryu JJ, Lee DY, Jung SK. A long-term longitudinal study of the osteoarthritic changes to the temporomandibular joint evaluated using a novel three-dimensional superimposition method. Sci Rep 2021; 11:9389. [PMID: 33931699 PMCID: PMC8087707 DOI: 10.1038/s41598-021-88940-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/20/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to assess the changes in individual condyles from 5 to 8 years in patients with temporomandibular joint (TMJ) osteoarthritis using 3-dimensional cone beam computed tomography (3D CBCT) reconstruction and superimposition. To assess the longitudinal TMJ changes, CBCT was performed at initial (T0) and final (T2) timepoints that were at least 5 years apart and at a middle (T1) timepoint. To improve the accuracy, we used a novel superimposition method that designated areas of coronoid process and mandibular body. The differences in the resorption and apposition amounts were calculated between each model via maximum surface distances. The greatest resorption and apposition observed were − 7.48 and 2.66 mm, respectively. Evaluation of the changes in each condyle showed that osteoarthritis leads to both resorption and apposition. Resorption was mainly observed in the superior region, while high apposition rates were observed (in decreasing order) in the posterior, lateral, and anterior regions. The medial parts showed greater apposition than the lateral parts in all regions. Our superimposition method reveals that both resorption and apposition were observed in condyles with TMJ osteoarthritis, and resorption/apposition patterns depend on the individual condyle and its sites.
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Affiliation(s)
- Kyungjae Han
- Department of Orthodontics, Korea University Guro Hospital, Seoul, 08308, Republic of Korea
| | - Mun Cheol Kim
- Department of Orthodontics, Graduate School of Clinical Dentistry, Korea University, Seoul, 02841, Republic of Korea
| | - Youn Joong Kim
- TMJ and Orofacial Pain Center, Ahrim Dental Hospital, Seoul, 06169, Republic of Korea
| | - Yunheon Song
- TMJ and Orofacial Pain Center, Ahrim Dental Hospital, Seoul, 06169, Republic of Korea
| | - Ilho Tae
- TMJ and Orofacial Pain Center, Ahrim Dental Hospital, Seoul, 06169, Republic of Korea
| | - Jae-Jun Ryu
- Department of Prosthodontics, Korea University Anam Hospital, Seoul, 02841, Republic of Korea
| | - Dong-Yul Lee
- Department of Orthodontics, Korea University Guro Hospital, Seoul, 08308, Republic of Korea
| | - Seok-Ki Jung
- Department of Orthodontics, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
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17
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Noh HK, Park HS. Considerations for vertical control with microimplants in a idiopathic condylar resorption patient: A case report. J Orthod 2021; 48:172-182. [PMID: 33761768 DOI: 10.1177/14653125211002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Idiopathic condylar resorption (ICR) is a rare, destructive temporomandibular joint disease characterised by progressive resorption of the condyles. This case report presents a record of an orthodontically treated patient with ICR with favourable posttreatment remodelling of the condyles. An 18-year-old woman sought treatment for ICR. A severe Class II high-angle facial pattern with resorption of bilateral condyles was evident. The treatment plan was determined after careful examination of condylar radiographs and comprised forward rotation of the mandible through full-arch intrusion with microimplants after extraction of the four premolars. The treatment was completed in 35 months, and the patient was noted to have a straight profile, good interdigitation and slightly increased condylar volume. Two years after retention, the condyles were stable, and the patient's profile and occlusion remained acceptable despite a mild relapse of the mandibular position. ICR was successfully corrected with orthodontic treatment. Counter-clockwise mechanics applied during the ICR remission period not only improved facial aesthetics but were also suitable for condylar unloading.
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Affiliation(s)
- Hyung-Kyu Noh
- School of Dentistry, Kyungpook National University, Jung-gu, Daegu, Republic of Korea
| | - Hyo-Sang Park
- School of Dentistry, Kyungpook National University, Jung-gu, Daegu, Republic of Korea
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18
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Zhou J, Fu Y, Yu L, Li Z, Chen S. A novel three-dimensional morphological analysis of idiopathic condylar resorption following stabilisation splint treatment. J Oral Rehabil 2021; 48:560-567. [PMID: 33539541 DOI: 10.1111/joor.13154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/30/2022]
Abstract
Bone modelling evaluation is important for monitoring idiopathic condylar resorption (ICR) progress. To compare condylar modelling in ICR patients treated with or without stabilisation splints (SSs). Eighty-four condyles from 84 ICR patients were studied: 42 received SS therapy (SS group); 42 received conventional therapy (control group). Cone-beam computed tomography images at diagnosis (T0) and after at least 6 months (T1) were used for three-dimensional reconstruction. Volume differences between T0 and T1 (δV) were used to evaluate the amount of modelling. Percentage of growth area (PCT) was used to assess the condylar surface growth tendency. No significant change in condylar volume was found in the SS group, whereas that in the control group was significantly decreased at T1 (P <.0001). The amount of modelling differed among condylar subregions within the SS group: among 6 subregions (P =.0137), between anterior and posterior regions (P =.0336) and between lateral, intermediate and medial regions (P =.0275). Control group condylar subregions showed no significant differences in the amount of modelling. The anabolic modelling tendency of the total condylar surface in the SS group was greater than that in the control group (P =.0251); however, there were no statistical differences in PCTs among condylar subregions in either group. SS therapy effectively reduced further bone destruction and promoted condylar modelling. Three-dimensional morphological analysis is a novel method that can accurately evaluate the amount of bone modelling and growth tendency in ICR patients.
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Affiliation(s)
- Jialiang Zhou
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yujie Fu
- School and Hospital of Stomatology, Tongji University, Shanghai Engineering Research Centre of Tooth Restoration and Regeneration, Shanghai, China
| | - Lixia Yu
- State Key Laboratory of Oral Disease, Department of Temporomandibular Joint, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ziyu Li
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Song Chen
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
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19
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Köhnke R, Ahlers MO, Birkelbach MA, Ewald F, Krueger M, Fiedler I, Busse B, Heiland M, Vollkommer T, Gosau M, Smeets R, Rutkowski R. Temporomandibular Joint Osteoarthritis: Regenerative Treatment by a Stem Cell Containing Advanced Therapy Medicinal Product (ATMP)-An In Vivo Animal Trial. Int J Mol Sci 2021; 22:E443. [PMID: 33466246 PMCID: PMC7795212 DOI: 10.3390/ijms22010443] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
Temporomandibular joint osteoarthritis (TMJ-OA) is a chronic degenerative disease that is often characterized by progressive impairment of the temporomandibular functional unit. The aim of this randomized controlled animal trial was a comparative analysis regarding the chondroregenerative potency of intra-articular stem/stromal cell therapy. Four weeks after combined mechanical and biochemical osteoarthritis induction in 28 rabbits, therapy was initiated by a single intra-articular injection, randomized into the following groups: Group 1: AB Serum (ABS); Group 2: Hyaluronic acid (HA); Group 3: Mesenchymal stromal cells (STx.); Group 4: Mesenchymal stromal cells in hyaluronic acid (HA + STx.). After another 4 weeks, the animals were euthanized, followed by histological examination of the removed joints. The histological analysis showed a significant increase in cartilage thickness in the stromal cell treated groups (HA + STx. vs. ABS, p = 0.028; HA + ST.x vs. HA, p = 0.042; STx. vs. ABS, p = 0.036). Scanning electron microscopy detected a similar heterogeneity of mineralization and tissue porosity in the subchondral zone in all groups. The single intra-articular injection of a stem cell containing, GMP-compliant advanced therapy medicinal product for the treatment of iatrogen induced osteoarthritis of the temporomandibular joint shows a chondroregenerative effect.
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Affiliation(s)
- Robert Köhnke
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Marcus Oliver Ahlers
- Department of Prosthetic Dentistry School of Dental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
- CMD-Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Moritz Alexander Birkelbach
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Florian Ewald
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany;
| | | | - Imke Fiedler
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (I.F.); (B.B.)
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (I.F.); (B.B.)
| | - Max Heiland
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, 14197 Berlin, Germany;
| | - Tobias Vollkommer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Rico Rutkowski
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
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Oh JW, Ahn YW, Jeong SH, Ju HM, Song BS, Ok SM. Prediction of anterior open-bite development after stabilization splint treatment in patients with temporomandibular disorder. Cranio 2020; 40:324-333. [DOI: 10.1080/08869634.2020.1792220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jae-Won Oh
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Republic of Korea
| | - Yong-Woo Ahn
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Republic of Korea
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Sung-Hee Jeong
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Republic of Korea
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Hye-Min Ju
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Republic of Korea
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Byong-Sop Song
- Department of Statistics, Graduate School of the Pusan National University, Busan, Republic of Korea
| | - Soo-Min Ok
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Republic of Korea
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
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Derwich M, Mitus-Kenig M, Pawlowska E. Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E225. [PMID: 32397412 PMCID: PMC7279162 DOI: 10.3390/medicina56050225] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.
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Affiliation(s)
- Marcin Derwich
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Maria Mitus-Kenig
- Department of Prophylaxis and Experimental Dentistry, Jagiellonian University in Krakow, 31-007 Krakow, Poland;
| | - Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
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Long-term Changes of Temporomandibular Joint Osteoarthritis on Computed Tomography. Sci Rep 2020; 10:6731. [PMID: 32317672 PMCID: PMC7174364 DOI: 10.1038/s41598-020-63493-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/30/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to understand long-term changes of the osteoarthritic temporomandibular joint (TMJ) condyle using computed tomography (CT) and to verify its correlation with clinical characteristics of temporomandibular disorders. Eighty-nine patients (152 joints; 76 female, 13 male) who had taken follow-up CTs (mean follow-up period: 644.58 ± 325.71 days) at least once in addition to their initial evaluation were selected. Cross-sectional demographic and clinical data and longitudinal CT images were collected. Data were analyzed by analysis of variance and logistic regression. Overall destructive change index (number of TMJ condyle sections in which destructive change was observed) decreased from 1.56 to 0.66. Improvement was seen in 93 joints (61.2%) and 27 joints (17.8%) worsened. In the pain positive group, both initial and final destructive change index were significantly higher compared to the pain negative group (p = 0.04). Occlusal stabilization splint therapy and nonsteroidal anti-inflammatory drug administration showed a significant effect on improving the prognosis of TMJ osteoarthritis (p = 0.015 and 0.011). In conclusion, TMJ osteoarthritis showed long-term improvement in the majority of cases. TMJ osteoarthritis accompanied by pain showed unfavorable prognosis with additional bone destruction. Occlusal stabilization splint and nonsteroidal anti-inflammatory drug administration were beneficial on the prognosis of TMJ osteoarthritis.
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Hong SW, Kang JH. Decreased mandibular cortical bone quality after botulinum toxin injections in masticatory muscles in female adults. Sci Rep 2020; 10:3623. [PMID: 32107437 PMCID: PMC7046747 DOI: 10.1038/s41598-020-60554-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
This study aimed to clarify how masticatory muscle atrophy induced by botulinum toxin (BTX) injection affects cortical bone quality of the mandible using 3D modeling technology. A total of 39 young (26.9 ± 6.0 years) and 38 post-menopausal (55.3 ± 6.3 years) females were included. Computed tomography (CT) images were obtained before and after 12 months of treatment. Predictor variables were application of a stabilization splint, and/or two times of BTX injection in the bilateral temporalis and masseter muscles within a six-month interval. Outcome variables were changes in average Hounsfield units (HU) and cortical thickness of region of interest (ROI). 3D mandibular models were reconstructed using CT images, and models were used to calculate average HU and cortical thickness of ROIs, including inferior half of the lateral surface of ascending ramus, coronoid process, and temporomandibular joint condyle. Cortical bone quality at muscle insertion site was influenced by decreased muscle thickness but seemed not to be affected by decreased functional loading. Reduced functional loading seemed to influence cortical bone quality of the condyles. These effects were more remarkable in post-menopausal females. Hence, decreased masticatory muscle thickness may lead to alterations of the mandibular cortical structures, especially in post-menopausal females.
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Affiliation(s)
- Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181, Korea
| | - Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea.
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Lin H, He Y, Feng Y, Huang F. Comparison of condylar morphology changes and position stability following unilateral and bilateral sagittal split mandibular ramus osteotomy in patients with mandibular prognathism. Head Face Med 2019; 15:18. [PMID: 31296246 PMCID: PMC6622001 DOI: 10.1186/s13005-019-0202-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/01/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Unilateral sagittal split ramus osteotomy (USSRO) is not widely used given the postoperative instability caused by the inevitable rotation of the mandibular segment during surgery. However, the influence of mandibular movement on the condylar morphology and position stability has not been completely explored. The aim of the study was to quantitatively evaluate the effect of USSRO on the condylar surface morphology changes and postoperative stability in patients with mandibular lateral prognathism and compare these findings with the classic bilateral sagittal split ramus osteotomy (BSSRO). PATIENTS/METHODS This was a retrospective study involving 134 patients with mandibular lateral prognathism who received USSRO (n = 56) and BSSRO (n = 78) surgery. Here, cone beam computed tomography (CBCT) was performed before surgery (T0), immediately after surgery (T1), and 1 year postoperatively (T2). Differences of condylar sizes, condylar surface deviation, and mandibular positioning parameters (dental midline deviation, SNB, SN-MP) were calculated from T0 to T2. Comparisons were performed at the deviated side or nondeviated side of condyles between the USSRO and BSSRO groups. The relation between the dental midline deviation and condylar surface morphology changes from T0 to T2 were investigated. RESULTS Condylar surface morphology changes at the deviated side of temporomandibular joint (TMJ) before and 1 year after the surgery were significantly different between the USSRO and BSSRO groups. The dental midline deviation was related to the changes of condylar volume, surface size and surface deviation at the deviated side of TMJ in patients following USSRO. No significant difference was noted between the USSRO and BSSRO groups for postoperative condylar surface morphology changes at the nondeviated side. In both groups, significant differences between T0 and T1 and no significant difference between T1 and T2 were noted for all of the mandibular positioning parameters. CONCLUSIONS Both BSSRO and USSRO exhibit favorable postoperative stability in the correction of mandibular prognathism. After USSRO surgery, condylar surface changes occurred at the deviated side of the TMJ, and the dental midline deviation was closely related to the changes of condylar surface morphology. USSRO represents a stable alternative for minor asymmetric mandibular prognathism correction with the advantages of reduced operating time and surgical trauma.
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Affiliation(s)
- Han Lin
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yifan He
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yifan Feng
- Department of Prothodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Fang Huang
- Department of Paediatric Dentistry, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Fang Huang, No.56 Lingyuan Xi Road, Guangzhou, Guangdong Province, People's Republic of China, 510055.
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Lei J, Yap AUJ, Liu MQ, Fu KY. Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: A randomised controlled study. J Oral Rehabil 2019; 46:704-714. [PMID: 31009097 DOI: 10.1111/joor.12805] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/08/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anterior repositioning splint (ARS) can facilitate regenerative condylar remodelling. OBJECTIVE To determine the effect of ARS on osseous condylar changes in adolescents/young adults with early-stage degenerative joint disease (DJD). METHODS Sixty-nine patients with early-stage temporomandibular joint (TMJ) DJD based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and cone beam computed tomography (CBCT) imaging were recruited and randomly allocated to two treatment groups: (a) conservative therapy with ARS and (b) conservative therapy without ARS. Subjects with acute TMJ closed-lock had their displaced discs physically reduced by mandibular manipulation prior to ARS therapy. Clinical and CBCT data of 59 patients (86.4% females, mean age 17.95 ± 4.53 years, 67 joints) were attained pre- and at 6 or 12 months post-treatment. Osseous changes after treatment were categorised into (a) progressed, (b) unchanged, (c) repaired (remodelled without new bone formation) and (d) regenerated (remodelled with new bone formation). Statistical analysis including chi-square test, independent samples t test or Mann-Whitney U test was conducted. RESULTS About 85.5% of patients (59/69) completed the study, with 28 subjects (32 joints) in the splint group and 31 (35 joints) in the control group. The occurrence of condylar repair and regeneration was significantly higher with ARS (78.1%/[25/32] of joints) when compared to control group (48.6%/[17/35]) (P < 0.05). Moreover, condylar regeneration was exclusively observed in 50%/(16/32) of joints with ARS. For the 14 joints in splint group that received physical TMJ closed-lock reduction, 85.7%/(12/14) exhibited condylar regeneration. The splint group (3.1%/[1/32]) also had significantly lower incidence of progressive TMJ degeneration than the control (37.1%/[13/35]) (P < 0.001). CONCLUSION Condylar repair and regeneration in early-stage TMJ DJD are possible, and ideal spatial disc-condyle relationship appears important. The possibility of restoring TMJ form/structure by ARS therapy presents an attractive area of new basic science and clinical research (Bone defect repair in early osteoarthrosis of temporomandibular joint by joint distraction therapy: A randomized controlled trial/ChiCTR-TRC-14005172).
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Affiliation(s)
- Jie Lei
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Adrian U-J Yap
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore.,Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - Mu-Qing Liu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Kai-Yuan Fu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Conte R, Forin Valvecchi F, Gracco AL, Bruno G, De Stefani A. Condylar dysfunctional remodeling and recortication: a case-control study. MINERVA STOMATOLOGICA 2019; 68:74-83. [PMID: 30854837 DOI: 10.23736/s0026-4970.19.04211-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Temporo-mandibular disorders (TMD) is a collective term comprehending different clinical issues involving masticatory muscles, temporo-mandibular joint (TMJ) and other associated structures. TMD diagnosis is not made for its pathogenesis or etiology, but mainly on clinical symptoms. Primary dysfunction develops mostly on four factors: individual predisposition, high psychomotor activity (due to stress or parafunction), occlusal instability and low or absent tissue adaptation capability. On the other hand, secondary disorders can be caused by hereditary or congenital diseases, rheumatic inflammatory diseases, autoimmune and tumoral diseases. During their function, the condyles undergo a structural adaptive and physiological remodeling, but when mechanical stress exceeds adaptive capability, dysfunctional remodeling phenomena may occur. It is characterized by significant condylar morphological modifications at the level of the head of the condyle (smaller condyle), break of cortical integrity and reduced mandibular ramus height with subsequent mandibular retrusion and articular function alteration. The aim of this study is to compare condylar recortication amount, and pain reduction after two different therapeutic protocols. METHODS This is a case-control study. Twenty TMD patients were chosen and each of them underwent a documentation protocol including extraoral and intraoral photographs, dental casts, casts mounting on the articulator to evaluate CPI (CO-CR discrepancy index) and cone beam computed tomography (CBCT) of the mandibular condyles taken in closed mouth position. For the radiographic evaluation, a Planmeca ProMax 3D Mid system was utilized with an acquiring volume of 80×80 mm dimension, exposition 90 kV, 10.0 mA, 12 seconds with a DAP (Dose Area Product) of 1094 mGy·cm2 for each condyle. The acquired volume was elaborated by the Planmeca Romexis software v. 3.2.0.R and TMJ module. Seven coronal cuts and 10 sagittal cuts were performed on the head of the condyle to highlight the amount of cortication, before and after the application of two different therapeutic protocols. Protocol number 1 (N.=10 patients) included the exclusive use of a splint, while protocol number 2 (N.=10 patients) included the use of a splint associated with pharmacological therapy (NSAIDs, antioxidant, omega 3). The revaluation was performed on asymptomatic patient after a period of 6-8 months. The pain for each patient was assessed by a Visual Analogue Scale (VAS) from 0 to 10, 0 meaning no pain and 10 the worst pain ever felt. The VAS was evaluated after 10 days from the beginning of the treatment, after 3 months and after 8 months at the end of the treatment. Statistical analyses were carried using a χ2 test (P value <0.05). RESULTS No significant differences in the amount of cortication were found in the radiographic revaluation between the two different therapeutic protocols, even though it was noticed that the use of medicaments brought to a resolution of the symptoms in a shorter period of time (P=0.00001 after 10 days; P=0.0251 after 3 months). CONCLUSIONS According to this study, pharmacological protocol in the therapy of TMD does not seem to affect condylar cortication. Medicaments although seem to accelerate the disappearance of clinic symptomatology, but more researches are needed to valid these findings.
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Affiliation(s)
- Roberto Conte
- Department of Neuroscience, University of Padua, Padua, Italy
| | | | | | - Giovanni Bruno
- Department of Neuroscience, University of Padua, Padua, Italy
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Kahn A, Kün-Darbois JD, Bertin H, Corre P, Chappard D. Mandibular bone effects of botulinum toxin injections in masticatory muscles in adult. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:100-108. [PMID: 31227452 DOI: 10.1016/j.oooo.2019.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/29/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Botulinum toxin (BTX) is injected into masticatory muscles to treat various conditions. Animal studies have demonstrated bone loss at the condylar and alveolar regions of the mandible after BTX injection into masticatory muscles. The aim of the present study was to investigate mandibular bone changes in patients who received BTX injections in masticatory muscles. STUDY DESIGN Twelve adult patients who received BTX injections into masticatory muscles were included in this study. Cone beam computed tomography (CBCT) was performed before and 12 months after the injection. The condylar and alveolar regions of the mandible were analyzed by using texture analysis of the CBCT images with the run length method. Condylar cortical thickness was measured, and 3-dimensional analysis of the mandible was also performed. Six patients who did not receive BTX injections were used as controls. RESULTS A run length parameter (gray level nonuniformity) was found to be increased in condylar and alveolar bones. A significant cortical thinning was found at the anterior portion of the right condyle. Three-dimensional analysis showed significant changes in the condylar bone and at the digastric fossa. No changes in mandibular angles were found. CONCLUSIONS This study identified mandibular bone changes in adult patients who received BTX injection into masticatory muscles.
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Affiliation(s)
- Alexis Kahn
- Department of Oral and Maxillofacial surgery, Chu d'Angers, Angers, Cedex, France; Department of Oral and Maxillofacial surgery, Chu de Nantes, Nantes, Cedex 1, France
| | - Jean-Daniel Kün-Darbois
- Department of Oral and Maxillofacial surgery, Chu d'Angers, Angers, Cedex, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, UNIV Angers, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Chu d'Angers, Angers, Cedex, France
| | - Helios Bertin
- Department of Oral and Maxillofacial surgery, Chu de Nantes, Nantes, Cedex 1, France
| | - Pierre Corre
- Department of Oral and Maxillofacial surgery, Chu de Nantes, Nantes, Cedex 1, France
| | - Daniel Chappard
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, UNIV Angers, SFR 42-08, IRIS-IBS Institut de Biologie en Santé, Chu d'Angers, Angers, Cedex, France.
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Aberrant activation of latent transforming growth factor-β initiates the onset of temporomandibular joint osteoarthritis. Bone Res 2018; 6:26. [PMID: 30210898 PMCID: PMC6131160 DOI: 10.1038/s41413-018-0027-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 02/05/2023] Open
Abstract
There is currently no effective medical treatment for temporomandibular joint osteoarthritis (TMJ-OA) due to a limited understanding of its pathogenesis. This study was undertaken to investigate the key role of transforming growth factor-β (TGF-β) signalling in the cartilage and subchondral bone of the TMJ using a temporomandibular joint disorder (TMD) rat model, an ageing mouse model and a Camurati–Engelmann disease (CED) mouse model. In the three animal models, the subchondral bone phenotypes in the mandibular condyles were evaluated by µCT, and changes in TMJ condyles were examined by TRAP staining and immunohistochemical analysis of Osterix and p-Smad2/3. Condyle degradation was confirmed by Safranin O staining, the Mankin and OARSI scoring systems and type X collagen (Col X), p-Smad2/3a and Osterix immunohistochemical analyses. We found apparent histological phenotypes of TMJ-OA in the TMD, ageing and CED animal models, with abnormal activation of TGF-β signalling in the condylar cartilage and subchondral bone. Moreover, inhibition of TGF-β receptor I attenuated TMJ-OA progression in the TMD models. Therefore, aberrant activation of TGF-β signalling could be a key player in TMJ-OA development. Blocking the activity of a critical growth factor could help treat degenerative disease of the jaw joint, according to experiments in three rodent models. Xuedong Zhou from Sichuan University in Chengdu, China, examined the cartilage and adjoining layer of bone found at the ends of the jawbone in a rat model of temporomandibular joint disorder and in two related mouse models. In all three, the researchers observed tissue abnormalities consistent with what’s seen in humans with osteoarthritis of the jaw joint, a condition with no effective therapeutic options. They showed that transforming growth factor-β, a master regulatory protein, displayed aberrant signalling patterns in these tissues and that blocking this protein’s receptor with a drug attenuated the disease process. The findings help explain what drives jaw joint osteoarthritis — and point to a strategy for treating it.
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Ferri J, Potier J, Maes JM, Rakotomalala H, Lauwers L, Cotelle M, Nicot R. Les arthrites de l’articulation temporomandibulaire : mise au point et attitude pratique en ODMF et ODF. Int Orthod 2018; 16:545-561. [PMID: 30017771 DOI: 10.1016/j.ortho.2018.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Joël Ferri
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France; Université de Lille, U1008, médicaments et biomatériaux à liberation contrôlée, 59000 Lille, France; Association internationale de médecine orale et maxillofaciale (AIMOM), 7 bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France.
| | - Julien Potier
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Jean-Michel Maes
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Hervey Rakotomalala
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Ludovic Lauwers
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France; Association internationale de médecine orale et maxillofaciale (AIMOM), 7 bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France
| | - Mickael Cotelle
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Romain Nicot
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
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Abstract
Rheumatic diseases (RD) of the temporomandibular joints (TMJs) are increasingly frequent affections and unfortunately often confused with "classic" manducatory dysfunctions (disk dislocation, myofascial pain syndroms). Their diagnosis is mandatory, given the major subsequent craniofacial disorders, which may occur (mandibular condylar hypoplasia, facial hyperdivergence, remodelling of the condylar unit, ankylosis), although the clinical implementation remains unspecific. The delayed diagnosis may be explained by the embryologic, anatomical and physiological characteristics of this joint. Magnetic resonance imaging (MRI), scans and more recently cone-beam computed tomography (CBCT) allow to diagnose its early signs (alteration of the disc-ligament complex, intra-articular effusion, osteochondral lesions). The treatment of TMJ rheumatic diseases (RD) is not consensual, and often includes a non surgical phase (hygiene and dietary rules, non-steroid anti-inflammatory drugs (NSAI), occlusal splints, and/or a surgical phase for the advanced stages (joint washing, orthognathic surgery, or joint surgery), and non responding patients to the medical treatment of inflammatory rheumatism. Orthodontics will be useful to correct dento-alveolar compensations, while monitoring, however, the impact on joint function.
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Ok SM, Jeong SH, Ahn YW, Kim YI. Effect of stabilization splint therapy on glenoid fossa remodeling in temporomandibular joint osteoarthritis. J Prosthodont Res 2016; 60:301-307. [DOI: 10.1016/j.jpor.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
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Effects of condylar head surface changes on mandibular position in patients with temporomandibular joint osteoarthritis. J Craniomaxillofac Surg 2015. [DOI: 10.1016/j.jcms.2015.06.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Wang XD, Zhang JN, Gan YH, Zhou YH. Current understanding of pathogenesis and treatment of TMJ osteoarthritis. J Dent Res 2015; 94:666-73. [PMID: 25744069 DOI: 10.1177/0022034515574770] [Citation(s) in RCA: 276] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Osteoarthritis is a common disease that can cause severe pain and dysfunction in any joint, including the temporomandibular joint (TMJ). TMJ osteoarthritis (TMJOA) is an important subtype in the classification of temporomandibular disorders. TMJOA pathology is characterized by progressive cartilage degradation, subchondral bone remodeling, and chronic inflammation in the synovial tissue. However, the exact pathogenesis and process of TMJOA remain to be understood. An increasing number of studies have recently focused on inflammation and remodeling of subchondral bone during the early stage of TMJOA, which may elucidate the possible mechanism of initiation and progression of TMJOA. The treatment strategy for TMJOA aims at relieving pain, preventing the progression of cartilage and subchondral bone destruction, and restoring joint function. Conservative therapy with nonsteroidal anti-inflammatory drugs, splint, and physical therapy, such as low-energy laser and arthrocentesis, are the most common treatments for TMJOA. These therapies are effective in most cases in relieving the signs and symptoms, but their long-term therapeutic effect on the pathologic articular structure is unsatisfactory. A treatment that can reverse the damage of TMJOA remains unavailable to date. Treatments that prevent the progression of cartilage degradation and subchondral bone damage should be explored, and regeneration for the TMJ may provide the ideal long-term solution. This review summarizes the current understanding of mechanisms underlying the pathogenesis and treatment of TMJOA.
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Affiliation(s)
- X D Wang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - J N Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Y H Gan
- Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China Central Laboratory, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
| | - Y H Zhou
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, Haidian District, Beijing, China
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