Observation of three cases of temporomandibular joint osteoarthritis and mandibular morphology during adolescence using helical CT

Methods in Genetic Analysis for Evaluation Mandibular Shape and Size Variations in Human Mandible

ABSTRACT

The human mandible has been investigated from both clinical and evolutionary perspectives. Recent advances in genome science have identified the genetic regulation of human mandibular shape and size. Identification of genes that regulate mandibular shape and size would not only enhance our understanding of the mechanisms of mandibular growth and development but also help define a strategy to prevent mandibular dysplasia. This review provides a comprehensive summary of why and how the mandible was evaluated in the human mandible genome study. The variation in human mandibular shape and size has been progressively clarified, not only by focusing on the mandible alone but also by using extremely diverse approaches. The methods of data acquisition for evaluating human mandibular shape and size variation are well established. Furthermore, this review explains how to proceed with future research.

Improvement of bone-erosive temporomandibular joint (TMJ) abnormalities in adolescents undergoing non-surgical treatment: a longitudinal study

OBJECTIVES

To investigate the longitudinal changes of the imaging temporomandibular joint (TMJ) characteristics in young patients with TMJ-related symptoms and treated with non-surgical methods. The severity of self-reported symptoms at follow-up was also investigated.

METHODS

A cone beam CT (CBCT)/CT follow-up examination [median follow-up 4.1 (1.3-6.4) years] was performed in 22 patients with erosive TMJ abnormalities [baseline median age 16 (12-18) years]. Imaging characteristics were analyzed and the changes between the examinations were categorized as (A) improvement, (B) no change, or (C) worsening. Severity of follow-up symptoms was evaluated using Jaw Functional Limitation Scale (JFLS-8) and Graded Chronic Pain Scale (Grade 0-IV). Analyses were performed separately for left and right TMJ. Findings at baseline and follow-up were compared using McNemar test to account for dependencies. Changes in proportions of hard tissue findings between examinations were assessed using Wilcoxon signed ranks test.

RESULTS

A significant reduction in the proportion of patients with erosive abnormalities was found [59.1%, 95% CI (36.4-79.3) %]. Baseline erosions improved in 9/12 (75%) right and 14/15 (93%) left TMJs. About half repaired; developed an intact cortical outline. Number of joints with osteophytes increased (right: p < 0.04, left: p < 0.003). New osteophytes were mostly found in joints with erosive findings. Low or no limitation of jaw function (Jaw Functional Limitation Scale) was found in 12/22 (55%) and no or low intensity of pain (Graded Chronic Pain Scale Grade 0 or I) in 19/22 (86%) at follow-up.

CONCLUSION

We found a high potential for repair of erosive TMJ abnormalities. However, the patient series was small. The majority of patients assessed their symptom severity at follow-up as low.

Comparison of the three-dimensional structures of mandibular condyles between adults with and without facial asymmetry: A retrospective study

OBJECTIVE

This retrospective study compared the three-dimensional (3D) structure of mandibular condyles between adults with and without facial asymmetry, and whether it influences menton deviation.

METHODS

Sixty adult patients were classified into symmetry and asymmetry groups based on the menton deviation on postero-anterior radiographs. The right/left differences of 3D measurements were compared between the two groups, and measurements were compared separately on the right and left sides. The correlations between menton deviation and the right/left differences were analyzed.

RESULTS

The mediolateral dimension, neck length, condylar angles to the anteroposterior reference (PO) and midsagittal reference planes, and neck and head volumes showed significantly larger right/left differences in the asymmetry group compared to the symmetry group. Separate comparisons of the right and left sides between the two groups showed that the neck was significantly shorter and neck and head volumes were significantly smaller on the left side, which was deviated side in the asymmetry group. Pearson's correlation analysis showed significant positive correlations of menton deviation with right/left differences in neck length, condylar angle to the PO plane, and neck and head volumes in the asymmetry group.

CONCLUSIONS

In individuals with facial asymmetry, menton deviation is associated with the right/left differences caused by a smaller condyle on the deviated side, particularly in neck length and neck and head volumes.

A study of temporomandibular joint osteoarthritis using computed tomographic imaging

Background

This study aimed to determine the various bony changes in osteoarthritis (OA) of elderly patients who are suffering from temporomandibular joint dysfunction (TMD) and to find if all the changes manifesting in generalized OA were presented in temporomandibular joint (TMJ).

Methods

Thirty TMJs of fifteen elderly patients who were diagnosed with TMD were selected for the study. Patient with TMD were subjected to computerized tomographic (CT) imaging, and the various bony changes in the TMJ were recorded.

Results

CT study of TMJ showed that there is a positive evidence of joint involvement in 80% of the cases. In this study, female patients were more commonly affected by OA than the males. The condylar changes (69.93%) are more common than the changes in the articular eminence (6.6%) and condylar fossa (10%). About 56.6% of TMJ in the study was affected by the early manifestations of the OA.

Conclusion

CT study showed that there is a positive evidence of TMJ involvement in the elderly patients with TMD. The results show that condylar changes are more common than the changes in the articular eminence and condylar fossa. The study also shows that most of the patients are affected by early TMJ OA; hence, initiating treatment at early stages may prevent the disease progression.

AMD3100 Attenuates Matrix Metalloprotease-3 and -9 Expressions and Prevents Cartilage Degradation in a Monosodium Iodo-Acetate-Induced Rat Model of Temporomandibular Osteoarthritis

PURPOSE

Temporomandibular joint osteoarthritis (TMJOA) is an important subtype of temporomandibular disorder. This study investigated the inflammatory role of the stromal cell-derived factor-1 (SDF-1) and C-X-C chemokine receptor-4 (CXCR4) axis and the probable signaling pathway involved in matrix metalloprotease (MMP)-3 and MMP-9 productions stimulated by the SDF-1-CXCR4 axis in an experimental rat model of TMJOA.

MATERIALS AND METHODS

Rats were randomly divided into a control group, a pathologic model group, and an AMD3100 group. Effects of the bicyclam derivative AMD3100 (the specific antagonist of SDF-1-CXCR4 axis) were studied in TMJOA experimentally induced by monosodium iodo-acetate. Productions of SDF-1 and CXCR4 were compared in the normal and pathologic model groups, and cartilage changes and expressions of MMP-3, MMP-9, and phosphorylated extracellular signal-regulated kinase (p-ERK) were compared in the control, pathologic model, and AMD3100 groups.

RESULTS

Expressions of SDF-1 and CXCR4 in the pathologic model group were increased compared with the control group (P < .05). Releases of MMP-3, MMP-9, and p-ERK and cartilage changes were downregulated in the AMD3100 group compared with the pathologic model group (P < .05), and these changes occurred in a dose-dependent manner with AMD3100 concentrations. Moreover, there were strong predictive relations between the expression of p-ERK with MMP-3 (r(2) = 0.419; P < .001) and with MMP-9 (r(2) = 0.542; P < .001).

CONCLUSIONS

The SDF-1-CXCR4 signaling pathway plays a proinflammatory role in experimental TMJOA, the bicyclam derivative AMD3100 can alleviate the severity of experimental TMJOA, and there might be a potential relation between the SDF-1-CXCR4 axis and the ERK signaling pathway.

Temporomandibular joint diagnostics using CBCT

The present review will give an update on temporomandibular joint (TMJ) imaging using CBCT. It will focus on diagnostic accuracy and the value of CBCT compared with other imaging modalities for the evaluation of TMJs in different categories of patients; osteoarthritis (OA), juvenile OA, rheumatoid arthritis and related joint diseases, juvenile idiopathic arthritis and other intra-articular conditions. Finally, sections on other aspects of CBCT research related to the TMJ, clinical decision-making and concluding remarks are added. CBCT has emerged as a cost- and dose-effective imaging modality for the diagnostic assessment of a variety of TMJ conditions. The imaging modality has been found to be superior to conventional radiographical examinations as well as MRI in assessment of the TMJ. However, it should be emphasized that the diagnostic information obtained is limited to the morphology of the osseous joint components, cortical bone integrity and subcortical bone destruction/production. For evaluation of soft-tissue abnormalities, MRI is mandatory. There is an obvious need for research on the impact of CBCT examinations on patient outcome.

Spontaneously developed osteoarthritis in the temporomandibular joint in STR/ort mice

Temporomandibular joint (TMJ) osteoarthritis is typically a slowly progressive asymmetric disease. Little is known regarding the natural destruction of TMJ articular tissues. The aim of the present study was to investigate morphological changes in the TMJ of STR/ort mice, known to be the model for spontaneous osteoarthritis in the knee joint, and to evaluate STR/ort mice as a suitable animal model for TMJ osteoarthritis. TMJs from 32 STR/ort mice euthanized at 30, 40, 50 or 60 weeks of age, and from 6 CBA mice euthanized at 30, 40 or 60 weeks of age were examined. Toluidine blue and tartrate-resistant acid phosphatase staining were used to assess histological changes in the articular cartilage. Morphological changes in the articular cartilage of the TMJ were evaluated using microcomputed tomography. At the age of 40-50 weeks, 17 (68%) of the 25 STR/ort mice had loss of articular cartilage on histology, with cavitation and erosion of the exposed bone and gradual changes in condylar shape. Furthermore, osteoarthritic morphological changes, and structural alterations were observed by microcomputed tomography. The STR/ort mouse strain appears to develop spontaneous osteoarthritis-like lesions in the TMJ with age, and would be a useful model to study the pathogenesis of TMJ osteoarthritis.

CT Images of a Severe TMJ Osteoarthritis and Differential Diagnosis with Other Joint Disorders

Osteoarthritis (OA) is the most common arthritis which affects the human body and can affect the temporomandibular joint (TMJ). The diagnosis of TMJ OA is essentially based on clinical examination. However, laboratory tests and radiographic exams are also useful to exclude other diseases. The diagnosis of OA may be difficult because of other TMJ pathologies that can have similar clinical and radiographic aspects. The purpose of this study was to describe an unusual case of bilateral TMJ OA in an advanced stage and discuss its most common clinical, laboratory, and radiographic findings, focusing on their importance in the differential diagnosis with other TMJ diseases. Erosion, sclerosis, osteophytes, flattening, subchondral cysts, and a reduced joint space were some of the radiographic findings in TMJ OA. We concluded that, for the correct differential diagnosis of TMJ OA, it is necessary to unite medical history, physical examination, laboratory tests, and radiographic findings. Computed tomography is the test of choice for evaluating bone involvement and for diagnosing and establishing the degree of the disease.

Dentofacial characteristics of patients with rheumatoid arthritis

OBJECTIVES

The aims of this study are to evaluate the dentofacial morphology of patients with rheumatoid arthritis (RA) and to compare the morphological data with those of healthy age- and sex-matched control subjects.

METHODS

Twenty-seven RA patients (mean age, 45.77 ± 8.64 years) and 25 healthy subjects (mean age, 44.80 ± 8.24 years) participated in this prospective study. Clinical and functional evaluations of the RA patients were assessed. The erythrocyte sedimentation rate, C-reactive protein level, rheumatoid factor level, and anti-citrullinated peptide antibodies (ACPA) titers of RA patients were determined, and DAS28 scores were calculated. Linear and angular measurements were performed on cephalometric tracings and condylar erosion was evaluated on lateral panoramic radiographs. Statistical comparison of the two groups was performed with an independent samples t test. Pearson correlation analysis was used to assess the relationship between the clinical and laboratory parameters.

RESULTS

Based on DAS28 scores, no patient with RA was in the remission period, 3 patients had low, 23 had medium, and 1 had high disease activity. Sixteen (59.26 %) patients with RA had positive ACPA titers. Lateral cephalometric radiographs revealed statistically significant difference between the two groups for the measurement of U1-NA (millimeter; p = 0.047), U1-NA (degrees; p = 0.031), L1-NB (degrees; p = 0.030), IMPA (L1-MP; p = 0.001), interincisal angle (U1-L1; degrees; p = 0.022) and midface length (Co-A; millimeter; p = 0.033). A significant positive linear correlation was found between disease duration time and DAS28 scores (r = 0.066, p = 0.040).

CONCLUSIONS

Dentoalveolar effects of RA on dentofacial morphology are more significant than the skeletal effects. Future studies with larger sample sizes are required to evaluate the exact effects of RA on dentofacial morphology.

CLINICAL RELEVANCE

Clinicians should consider the fact that RA-associated dentoalveolar changes can be observed and may affect the orthodontic treatment process.

Osteoarthritic changes and condylar positioning of the temporomandibular joint in Korean children and adolescents

Purpose

To investigate the prevalence of osteoarthritic changes and condylar positioning of the temporomandibular joint (TMJ) in Korean children and adolescents with or without temporomandibular disorders (TMDs).

Materials and Methods

A total of 101 asymptomatic and 181 symptomatic children and adolescents aged 10 to 18 years old were included in the study. Osteoarthritic changes such as flattening, sclerosis, osteophytes, or erosion, and the parasagittal positioning of the condyle were assessed using cone-beam computed tomography (CBCT) images.

Results

The overall prevalence of osteoarthritic changes was higher in symptomatic (26.8%) than in asymptomatic adolescents (9.9%) (p<0.05). In the symptomatic group, the frequency was higher in males (33.3%) than in females (23.0%) (p<0.05). Erosion was the most common change for the symptomatic group (15.6%), whereas sclerosis was the most common change for the asymptomatic group (5.4%). Posterior condylar position was more frequently observed in the symptomatic group (p<0.05). Erosion was more common in the samples with TMJ pain or mouth opening limitations as compared to those without them (p<0.05).

Conclusion

This study showed that osteoarthritic changes in TMJ were common in children and adolescents, with a much higher prevalence in symptomatic patients.

Relationship between the thickness of the roof of glenoid fossa, condyle morphology and remaining teeth in asymptomatic European patients based on cone beam CT data sets

OBJECTIVES

The aim of this study was to examine the relationship between the roof of the glenoid fossa (RGF) thickness and condyle morphology and the influence of the number of remaining teeth and age.

METHODS

Cone beam CT data sets from 77 asymptomatic European patients were analysed retrospectively in this study. The thinnest area of RGF was identified among the sagittal and coronal slices on a computer screen; distance measurement software was used to measure the thickness. Moreover, we applied a free digital imaging and communications in medicine viewer for classification of condyle head type. It was also used to analyse any relation between RGF thickness and the number of remaining teeth. We performed a correlation analysis for RGF, age and missing teeth. Finally, we investigated combining sagittal condyle morphological characterization with coronal condyle morphology in relation to the number of joints and RGF thickness.

RESULTS

The Kruskal-Wallis test revealed no significant differences in RGF thickness among any of the coronal condyle head morphology groups (p > 0.05). There were significant differences in the thinnest part of RGF in relation to the sagittal plane for condyle morphological characterization, because we observed increased RGF thickness in joints with osteoarthritis features (p < 0.05). There is a non-significant correlation between the thinnest part of the RGF and the number of remaining teeth (p > 0.05).

CONCLUSIONS

We found that the RGF thickness is unaffected by the coronal condyle head morphology and the number of remaining teeth. Osteoarthritic changes (sagittal condyle morphology) have an effect on RGF.

Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: a CT evaluation

OBJECTIVE

Osseous changes in the temporomandibular joint (TMJ) were evaluated using computed tomography (CT) examinations before and after TMJ injections of sodium hyaluronate or a corticosteroid in patients with osteoarthritis (OA).

STUDY DESIGN

Forty patients were randomly allocated into 2 groups for 2 intra-articular injections with either sodium hyaluronate or a corticosteroid. Bilateral TMJ examinations with high resolution CT were obtained in 36 patients before and 6 months after treatment. Treated and contralateral TMJs were evaluated for the presence of osteoarthritic osseous abnormalities by 2 reviewers independently.

RESULTS

Progression, regression, and no changes of osseous abnormalities were demonstrated in 13, 9, and 14 TMJs, respectively, 6 months after treatment. There was no significant difference between the groups.

CONCLUSIONS

Progression/regression and no changes of osteoarthritic abnormalities were observed on CT examinations in both the treated and the contralateral TMJs after treatment with intra-articular injection with sodium hyaluronate or corticosteroid.

Mandibular antegonial and ramus notch depths and condylar bone change

The present study sought to clarify the relationship between antegonial and ramus notch depths and condylar bone change, and analyse the effects of such change on craniofacial structure. The study sample was of 28 pre-orthodontic patients with signs and symptoms of temporomandibular joint (TMJ) disorders, who underwent helical computed tomography to diagnose their TMJ pathology. Craniofacial structures were compared between 14 subjects with bilateral condylar bone change (BBC group: two male and 12 female) and 14 subjects with no bone change (NBC group: two male and 12 female). Sella-nasion-point B (SNB) and point A-nasion-point B (ANB) angles were significantly smaller in BBC than in NBC, with ramus height and mandibular body lengths significantly shorter in BBC than in NBC. The BBC lower facial height and SN-Go-Ar angle, as well as antegonial and ramus notch depths, were significantly greater than in NBC, and the mandible was significantly more retruded in BBC than in NBC. These results showed that condylar bone change might be related not only to mandibular size (e.g. retrusion) but also to mandibular outline (including antegonial and ramus notch depth).