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Abdallah AMA, El Fadly MAEA, Abdelfateh SMG, Taha MMS. Efficacy of Duloxetine With Arthrocentesis in the Management of TMJ Internal Derangement. J Craniofac Surg 2024; 35:1236-1240. [PMID: 38727210 DOI: 10.1097/scs.0000000000010266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 06/04/2024] Open
Abstract
Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction associated with internal derangement. Several adjunctive therapies have been used in combination with arthrocentesis in an attempt to increase its efficacy and long-term maintenance. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor which is used in different chronic pain conditions. This study aimed to assess the efficacy of duloxetine in combination with arthrocentesis compared with arthrocentesis alone. Twenty-eight patients with chronic TMJ pain were included and randomly allocated into 2 groups (control and study groups). The control group included patients who underwent TMJ arthrocentesis only, and the study group included patients who underwent arthrocentesis followed by giving duloxetine (30 mg) orally twice daily for 3 months. Pain, maximum mouth opening, and level of anxiety and depression were assessed preoperatively and followed at regular intervals of 1 week, 1 month, 3 months, and 6 months postoperatively. Pain was significantly reduced in both groups at all postoperative intervals and was significantly lower in the study group than the control group at 6 months. Maximum mouth opening increased significantly in both groups, but the difference between them was not significant. Level of anxiety and depression was significantly decreased in both groups, with no statistically significant difference between them. The results of this study indicate that duloxetine in combination with arthrocentesis may provide effective and long-term pain control; however, its use is associated with a higher risk of adverse events.
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Kakimoto N, Wongratwanich P, Shimamoto H, Kitisubkanchana J, Tsujimoto T, Shimabukuro K, Verdonschot RG, Hasegawa Y, Murakami S. Comparison of T2 values of the displaced unilateral disc and retrodiscal tissue of temporomandibular joints and their implications. Sci Rep 2024; 14:1705. [PMID: 38242921 PMCID: PMC10798969 DOI: 10.1038/s41598-024-52092-6] [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: 09/10/2023] [Accepted: 01/13/2024] [Indexed: 01/21/2024] Open
Abstract
Unilateral anterior disc displacement (uADD) has been shown to affect the contralateral joints qualitatively. This study aims to assess the quantitative T2 values of the articular disc and retrodiscal tissue of patients with uADD at 1.5 Tesla (T). The study included 65 uADD patients and 17 volunteers. The regions of interest on T2 maps were evaluated. The affected joints demonstrated significantly higher articular disc T2 values (31.5 ± 3.8 ms) than those of the unaffected joints (28.9 ± 4.5 ms) (P < 0.001). For retrodiscal tissue, T2 values of the unaffected (37.8 ± 5.8 ms) and affected joints (41.6 ± 7.1 ms) were significantly longer than those of normal volunteers (34.4 ± 3.2 ms) (P < 0.001). Furthermore, uADD without reduction (WOR) joints (43.3 ± 6.8 ms) showed statistically higher T2 values than the unaffected joints of both uADD with reduction (WR) (33.9 ± 3.8 ms) and uADDWOR (38.9 ± 5.8 ms), and the affected joints of uADDWR (35.8 ± 4.4 ms). The mean T2 value of the unaffected joints of uADDWOR was significantly longer than that of healthy volunteers (P < 0.001). These results provided quantitative evidence for the influence of the affected joints on the contralateral joints.
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Affiliation(s)
- Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Pongsapak Wongratwanich
- Division of Oral Diagnosis, Department of Oral Biomedical Sciences, Khon Kaen University, Khon Kaen, Thailand.
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Jira Kitisubkanchana
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Tomomi Tsujimoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yoko Hasegawa
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shumei Murakami
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Osaka, Japan
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Di Paolo C, Qorri E, Falisi G, Gatto R, Tari SR, Scarano A, Rastelli S, Inchingolo F, Di Giacomo P. RA.DI.CA. Splint Therapy in the Management of Temporomandibular Joint Displacement without Reduction. J Pers Med 2023; 13:1095. [PMID: 37511708 PMCID: PMC10381538 DOI: 10.3390/jpm13071095] [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: 06/07/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The purpose of this study is to report clinical and instrumental changes after RA.DI.CA splint therapy for temporomandibular joint disc displacement without reduction. METHODS Subjects affected by disc dislocation without reduction were recruited between July 2020 and May 2022 based on inclusion and exclusion criteria and treated with RA.DI.CA. splints over a period of 6 months. Clinical data were collected at each phase of the study (T0, T1, T2). Magnetic resonance imaging and electrognathography data were recorded at the beginning (T0) and at the end (T2) of the study. ANOVA with post-hoc contrasts was performed to assess differences in outcome measures over time. The Wilcoxon test was used to evaluate changes in disc-condyle angle between before- and after-treatment MRI. A two-tailed value of p < 0.05 was regarded as significant. METHODS Ten patients completed the study. There were statistically significant differences over time for arthralgia, headache, neck pain, and mouth opening. Disc recapture and an improved quality of mandibular movement were recorded in 70% of subjects. The clinical and instrumental improvements are probably due to the orthopedic action of RA.DI.CA splint treatment, which allows for a greater degree of joint mobilization. CONCLUSIONS The purpose of this therapy is to recover the disc position if possible and achieve an adequate joint functional adaptation that avoids the progression of the structural damage and the recurrence of symptoms.
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Affiliation(s)
- Carlo Di Paolo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00185 Roma, Italy
| | - Erda Qorri
- Department of Dentistry, Faculty of Medical Sciences, Albanian University, 1001 Tirana, Albania
| | - Giovanni Falisi
- Department of Life Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Roberto Gatto
- Department of Life Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Sergio Rexhep Tari
- Department of Innovative Technology in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Antonio Scarano
- Department of Innovative Technology in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sofia Rastelli
- Department of Life Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Paola Di Giacomo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00185 Roma, Italy
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Qiao Y, Li J, Yuh C, Ko F, Mercuri LG, Alkhudari J, Pourzal R, Oh CD. Chemokine Regulation in Temporomandibular Joint Disease: A Comprehensive Review. Genes (Basel) 2023; 14:408. [PMID: 36833336 PMCID: PMC9956915 DOI: 10.3390/genes14020408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Temporomandibular joint disorders (TMDs) are conditions that affect the muscles of mastication and joints that connect the mandible to the base of the skull. Although TMJ disorders are associated with symptoms, the causes are not well proven. Chemokines play an important role in the pathogenesis of TMJ disease by promoting chemotaxis inflammatory cells to destroy the joint synovium, cartilage, subchondral bone, and other structures. Therefore, enhancing our understanding of chemokines is critical for developing appropriate treatment of TMJ. In this review, we discuss chemokines including MCP-1, MIP-1α, MIP-3a, RANTES, IL-8, SDF-1, and fractalkine that are known to be involved in TMJ diseases. In addition, we present novel findings that CCL2 is involved in β-catenin-mediated TMJ osteoarthritis (OA) and potential molecular targets for the development of effective therapies. The effects of common inflammatory factors, IL-1β and TNF-α, on chemotaxis are also described. In conclusion, this review aims to provide a theoretical basis for future chemokine-targeted therapies for TMJ OA.
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Affiliation(s)
- Yusen Qiao
- Department of Orthopedic Surgery, 1st Affiliated Hospital of Soochow University, Suzhou 215005, China
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jun Li
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19107, USA
| | - Catherine Yuh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Frank Ko
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Louis G. Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Bioengineering, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Jad Alkhudari
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Chun-do Oh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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Barry F, Chai F, Chijcheapaza-Flores H, Garcia-Fernandez MJ, Blanchemain N, Nicot R. Comparison of chemical-induced temporomandibular osteoarthritis rat models (monosodium iodoacetate versus collagenase type II) for the study of prolonged drug delivery systems. PLoS One 2023; 18:e0281135. [PMID: 36719872 PMCID: PMC9888674 DOI: 10.1371/journal.pone.0281135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To compare two agents that can induce a rat model of temporomandibular joint osteoarthritis (TMJOA) by chemical induction: monosodium iodoacetate (MIA) and collagenase type 2 (Col-2). We wished to ascertain the best agent for assessing drug-delivery systems (DDSs). METHOD Male Wistar rats underwent intra-articular injection with MIA or Col-2. They were manipulated for 30 days. The head withdrawal threshold (HWT), immunohistological assessment, and positron emission tomography (PET) were used to evaluate the relevance of our models. RESULTS For both the MIA and Col-2 groups, pain persisted for 30 days after injection. Change in the HWT showed that Col-2 elicited a strong action initially that decreased progressively. MIA had a constant action upon pain behavior. Histology of TMJ tissue from both groups showed progressive degradation of TMJ components. CONCLUSIONS MIA and Col-2 induced orofacial pain by their local chemical action on TMJs. However, based on a prolonged and greater sustained effect on the pain threshold, persistent histological changes, and imaging results, MIA appeared to be more suitable for creation of a rat model of TMJOA for the study of DDSs.
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Affiliation(s)
- Florent Barry
- INSERM, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, University of Lille, Lille, France
- * E-mail:
| | - Feng Chai
- INSERM, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, University of Lille, Lille, France
| | - Henry Chijcheapaza-Flores
- INSERM, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, University of Lille, Lille, France
| | - Maria José Garcia-Fernandez
- INSERM, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, University of Lille, Lille, France
| | - Nicolas Blanchemain
- INSERM, CHU Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, University of Lille, Lille, France
| | - Romain Nicot
- INSERM, CHU Lille, Department of Oral and Maxillofacial Surgery, University of Lille, Lille, France
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Bi R, Chen K, Wang Y, Luo X, Li Q, Li P, Yin Q, Fan Y, Zhu S. Regulating Fibrocartilage Stem Cells via TNF-α/Nf-κB in TMJ Osteoarthritis. J Dent Res 2021; 101:312-322. [PMID: 34515572 DOI: 10.1177/00220345211037248] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this study, we investigate harnessing fibrocartilage stem cell (FCSC) capacities by regulating tumor necrosis factor α (TNF-α) signaling for cartilage repair in temporomandibular joint osteoarthritis (TMJOA). Stem cell specifics for FCSCs were characterized in the presence of TNF-α. Etanercept as a TNF-α inhibitor and BAY 11-7082 as an Nf-κB inhibitor were used to study TNF-α regulation of FCSCs. Lineage tracing was performed in Gli1-CreERT+;Tmfl/fl mice when etanercept (1 mg/kg, every 3 d) or isometric vehicle was subcutaneously injected to trace specific changes in FCSCs. Surgically induced TMJOA Sprague-Dawley rats were generated with BAY 11-7082 (5 mg/kg, every 3 d) or vehicle subcutaneous injection to investigate the functional role of TNF-α/Nf-κB in TMJOA. Anterior disc displacement (ADD) rabbits were used to analyze the therapeutic effect of etanercept as a TMJOA intra-articular treatment with etanercept (0.02 mg in 100 μL, every 2 wk) or isometric vehicle. In vitro, TNF-α inhibited proliferation of FCSCs and increased FCSC apoptosis. TNF-α activation interfered with osteogenic and chondrogenic differentiation of FCSCs, while etanercept could partially recover FCSC specificity from TNF-α. FCSC lineage tracing in Gli1-CreERT+;Tmfl/fl mice showed that the chondrogenic capacity of Gli1+ cell lineage was markedly suppressed in osteoarthritis cartilage, the phenotype of which could be significantly rescued by etanercept. Specifically blocking the Nf-κB pathway could significantly weaken the regulatory effect of TNF-α on FCSC specificity in vitro and in TMJOA rats in vivo. Finally, intra-articular etanercept treatment efficiently rescued TMJ cartilage degeneration and growth retardation in ADD rabbits. Inhibition of TNF-α signaling reduced Nf-κB transcripts and recovered FCSC specificities. In vivo, etanercept treatment effectively rescued the osteoarthritis phenotype in TMJOA mice and ADD rabbits. These data suggest a novel therapeutic mechanism whereby TNF-α/Nf-κB inhibition promotes FCSC chondrogenic capacity for cartilage transformation in TMJOA.
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Affiliation(s)
- R Bi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - K Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Q Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - P Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Q Yin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y Fan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - S Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Jin Y, Wei S, Liu TT, Qiu CY, Hu WP. Acute P38-Mediated Enhancement of P2X3 Receptor Currents by TNF-α in Rat Dorsal Root Ganglion Neurons. J Inflamm Res 2021; 14:2841-2850. [PMID: 34234509 PMCID: PMC8254564 DOI: 10.2147/jir.s315774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Tumor necrosis factor-α (TNF-α) is a pro-inflammatory cytokine and involves in a variety of pain conditions. Some findings suggest that TNF-α may act directly on primary afferent neurons to induce acute pain hypersensitivity through non-transcriptional regulation. This study investigated whether TNF-α had an effect on functional activity of P2X3 receptors in primary sensory neurons. Herein, we report that a brief (5 min) application of TNF-α rapidly enhanced the electrophysiological activity of P2X3 receptors in rat dorsal root ganglia (DRG) neurons. Methods Electrophysiological recordings were carried out on rat DRG neurons, and nociceptive behavior was quantified in rats. Results A brief (5 min) exposure of TNF-α rapidly increased P2X3 receptor-mediated and α,β-methylene-ATP (α,β-meATP)-evoked inward currents in a dose-dependent manner. The potentiation of P2X3 receptor-mediated ATP currents by TNF-α was voltage-independent. TNF-α shifted the concentration-response curve for α,β-meATP upwards, with an increase of 31.57 ± 6.81% in the maximal current response to α,β-meATP. This acute potentiation of ATP currents by TNF-α was blocked by p38 mitogen-activated protein kinase (MAPK) inhibitor SB202190, but not by non-selective cyclooxygenase inhibitor indomethacin, suggesting involvement of p38 MAPK, but not cyclooxygenase. Moreover, intraplantar injection of TNF-α and α,β-meATP produced a synergistic effect on mechanical allodynia in rats. TNF-α-induced mechanical allodynia was also alleviated after local P2X3 receptors were blocked. Conclusion These results suggested that TNF-α rapidly sensitized P2X3 receptors in primary sensory neurons via a p38 MAPK dependent pathway, which revealed a novel peripheral mechanism underlying acute mechanical hypersensitivity by peripheral administration of TNF-α.
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Affiliation(s)
- Ying Jin
- Research Center of Basic Medical Sciences, School of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, Hubei, 437100, People's Republic of China
| | - Shuang Wei
- Research Center of Basic Medical Sciences, School of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, Hubei, 437100, People's Republic of China
| | - Ting-Ting Liu
- Research Center of Basic Medical Sciences, School of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, Hubei, 437100, People's Republic of China
| | - Chun-Yu Qiu
- Research Center of Basic Medical Sciences, School of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, Hubei, 437100, People's Republic of China
| | - Wang-Ping Hu
- Research Center of Basic Medical Sciences, School of Basic Medical Sciences, Hubei University of Science and Technology, Xianning, Hubei, 437100, People's Republic of China
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Greene CS, Manfredini D. Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis. J Oral Rehabil 2021; 48:1077-1088. [PMID: 33966303 PMCID: PMC8453911 DOI: 10.1111/joor.13180] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
Background Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated. Methods This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field. Results At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors. Conclusions The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.
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Affiliation(s)
- Charles S Greene
- Department of Orthodontics, University of Illinois at Chicago College of Dentistry, Chicago, IL, USA
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
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Kang MG, Park YJ, Huh KH, Kho HS. Clinical characteristics of temporomandibular disorders presenting posterior open bite - A report of 12 cases. J Dent Sci 2021; 16:861-867. [PMID: 34141100 PMCID: PMC8189876 DOI: 10.1016/j.jds.2020.12.005] [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: 11/30/2020] [Revised: 12/03/2020] [Indexed: 12/01/2022] Open
Abstract
Background/purpose There is a paucity of comprehensive information about posterior open bite (POB) in patients with temporomandibular disorders (TMD) because of its rare prevalence. The purpose of this study was to investigate the etiologies, clinical characteristics, and treatment outcomes of patients with TMD presenting POB. Materials and methods This study includes a careful review of medical records and imaging findings of 12 patients with TMD (seven men and five women, 50.9 ± 19.2 years, 15–72 years) complaining of POB. Results In total, 11 had unilateral POB, whereas 1 had bilateral POB. In 11 patients, POB was caused by inflammatory disorders of temporomandibular joint (TMJ). In the remaining one patient, TMJ medial disc displacement (MDD) was responsible for POB. Of 11 patients with inflammatory conditions of TMJ, four patients had unilateral TMJ internal derangement (ID), two had bilateral TMJ ID, and one had rheumatism. POB was resolved in 10 of 11 patients with TMJ inflammation following the administration of non-steroidal anti-inflammatory drugs and self-management instructions. Prosthodontic treatment was needed in one patient to resolve POB. POB was resolved in the patient with TMJ MDD after stabilization splint therapy. Conclusion POB in patients with TMD was mostly caused by inflammatory disorders of TMJ. TMJ MDD could also be a reason. Although almost all POB was resolved by conservative treatments including medications, the possibility of prosthodontic, orthodontic, or surgical treatments also must be considered.
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Affiliation(s)
- Min-Goo Kang
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Yu-Jin Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hong-Seop Kho
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea.,Institute on Aging, Seoul National University, Seoul, Republic of Korea
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Doshi TL, Nixdorf DR, Campbell CM, Raja SN. Biomarkers in Temporomandibular Disorder and Trigeminal Neuralgia: A Conceptual Framework for Understanding Chronic Pain. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:1-18. [PMID: 32923920 PMCID: PMC7486013 DOI: 10.1080/24740527.2019.1709163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In this review, we will explore the use of biomarkers in chronic pain, using the examples of two prototypical facial pain conditions: trigeminal neuralgia and temporomandibular disorder. We will discuss the main categories of biomarkers and identify various genetic/genomic, molecular, neuroradiological, and psychophysical biomarkers in both facial pain conditions, using them to compare and contrast features of neuropathic, nonneuropathic, and mixed pain. By using two distinct model facial pain conditions to explore pain biomarkers, we aim to familiarize readers with different types of biomarkers currently being studied in chronic pain and explore how these biomarkers may be used to develop new precision medicine approaches to pain diagnosis, prognosis, and management.
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Affiliation(s)
- Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Donald R Nixdorf
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Chidambaran V, Gang Y, Pilipenko V, Ashton M, Ding L. Systematic Review and Meta-Analysis of Genetic Risk of Developing Chronic Postsurgical Pain. THE JOURNAL OF PAIN 2019; 21:2-24. [PMID: 31129315 DOI: 10.1016/j.jpain.2019.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/06/2019] [Accepted: 05/20/2019] [Indexed: 02/08/2023]
Abstract
Chronic postsurgical pain (CPSP) is a significant detriment to postsurgical recovery and a risk factor for prolonged opioid use. Emerging evidence suggests the estimated heritability for chronic pain is 45% and that genetic factors partially explain individual susceptibility to CPSP. The aim of this study was to systematically review, assess quality, and summarize the studies in humans that have investigated genetic factors associated with CPSP. We also conducted a meta-analysis to derive a single effect size for evaluable genetic associations with CPSP. Our comprehensive literature search included review of 21 full-text articles evaluating variants of 69 genes for association with CPSP. We found significant gene variant associations reported for variants/haplotypes of 26 genes involved in neurotransmission, pain signaling, immune responses and neuroactive ligand-receptor interaction, with CPSP. Six variants of 5 genes (COMT: rs4680 and rs6269, OPRM1: rs1799971, GCH1: rs3783641, KCNS1: rs734784 and TNFA: rs1800629), were evaluated by more than one study and were included in the meta-analysis. At rs734784 (A>G) of KCNS1, presence of G allele marginally increased risk of CPSP (Additive genetic model; Odds ratio: 1.511; 95% CI 1-2.284; P value: .050), while the other variants did not withstand meta-analyses criteria. Our findings demonstrate the role of genetic factors with different functions in CPSP, and also emphasize that single genetic factors have small effect sizes in explaining complex conditions like CPSP. Heterogeneity in surgical cohorts, population structure, and outcome definitions, as well as small number of available studies evaluating same variants, limit the meta-analysis. There is a need for large-scale, homogenous, replication studies to validate candidate genes, and understand the underlying biological networks underpinning CPSP. PERSPECTIVE: Our systematic review comprehensively describes 21 studies evaluating genetic association with CPSP, and limitations thereof. A meta-analysis of 6 variants (5 genes) found marginally increased risk for CPSP associated with rs734784 A>G of the potassium voltage-gated channel gene (KCNS1). Understanding genetic predisposition for CPSP will enable prediction and personalized management.
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Affiliation(s)
- Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
| | - Yang Gang
- Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Valentina Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria Ashton
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lili Ding
- Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Is Repeated Arthrocentesis Beneficial in the Treatment of Temporomandibular Disorders: A Retrospective Study. J Oral Maxillofac Surg 2019; 77:1359-1364. [PMID: 30825439 DOI: 10.1016/j.joms.2019.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Arthrocentesis is an effective, simple, and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of 1- versus 2-session arthrocentesis procedures in the management of TMJ CL. MATERIALS AND METHODS A retrospective cohort study was conducted using the files of patients with TMJ CL according to diagnostic criteria for temporomandibular disorders. Patients who underwent 1- or 2-session arthrocentesis were included in the study. The decision of whether to undergo 1- or 2-session arthrocentesis was made by the patients: Those who accepted a second arthrocentesis procedure were assigned to group 1 (repeated arthrocentesis group), and those who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (scored on a visual analog scale) and maximum mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of 1- or 2-session arthrocentesis, MMO and pain score (on a visual analog scale) before treatment and at 1, 3, and 6 months' follow-up were analyzed. Descriptive, comparative, correlation, and multivariate analyses were conducted. RESULTS A total of 30 patients (25 female and 5 male patients) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decreases in pain scores and increases in MMO values were observed in both treatment groups at 3 and 6 months (P < .05). At 6 months, MMO values were significantly higher and pain levels were significantly lower in patients who received 2 arthrocentesis procedures. CONCLUSIONS Repeated arthrocentesis is more successful at reducing pain and improving MMO than a single intervention in the treatment of TMJ CL.
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Soni A. Arthrocentesis of Temporomandibular Joint- Bridging the Gap Between Non-Surgical and Surgical Treatment. Ann Maxillofac Surg 2019; 9:158-167. [PMID: 31293946 PMCID: PMC6585213 DOI: 10.4103/ams.ams_160_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The temporomandibular joint forms one of the most fascinating and complex synovial joints in the body. Movements of the temporomandibular joint are regulated by an intricate neurological controlling mechanism, which is essential for the system to function normally and efficiently. Lack of such harmony may cause disruptive muscle behavior or structural damage to any of the components. The management of refractory pain and dysfunctions in the temporomandibular joint poses challenge both to the oral physician and maxillofacial surgeon. Arthrocentesis is a simple, minimally invasive technique that can be used instead of more invasive procedures in patients with pain that fails to respond to conventional conservative measures. This review provides a full comprehensive overview of the literature about the various technical and prognostic aspects in relation to arthrocentesis of the temporomandibular joint, and every clinician must take into account this consideration when performing this procedure in treating patients with temporomandibular disorders.
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Affiliation(s)
- Abhishek Soni
- Department of Oral Medicine and Radiology, Modern Dental College and Research Center, Indore, Madhya Pradesh, India
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Alves SM, Freitas RS, do Val DR, Vieira LV, de Assis EL, Gomes FIF, Gadelha CADA, Gadelha TS, de Lacerda JTJG, Clemente-Napimoga JT, Pinto VDPT, Cristino Filho G, Bezerra MM, Chaves HV. The efficacy of a lectin from Abelmoschus Esculentus depends on central opioid receptor activation to reduce temporomandibular joint hypernociception in rats. Biomed Pharmacother 2018; 101:478-484. [DOI: 10.1016/j.biopha.2018.02.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 12/28/2022] Open
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Albuquerque A, Fonteles C, do Val D, Chaves H, Bezerra M, Pereira K, de Barros Silva P, de Lima B, Soares E, Ribeiro T, Costa F. Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1β in third molar surgery: a triple-blind, randomized, placebo-controlled study. Int J Oral Maxillofac Surg 2017; 46:1615-1625. [DOI: 10.1016/j.ijom.2017.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/08/2017] [Accepted: 05/10/2017] [Indexed: 11/29/2022]
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Eddelman D, Byrne R, Arvanitis LD. Inflammatory effusion of the temporomandibular joint with intracranial extension into the middle fossa: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bae S, Park MS, Han JW, Kim YJ. Correlation between pain and degenerative bony changes on cone-beam computed tomography images of temporomandibular joints. Maxillofac Plast Reconstr Surg 2017; 39:19. [PMID: 28730147 PMCID: PMC5496923 DOI: 10.1186/s40902-017-0117-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/20/2017] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to assess correlation between pain and degenerative bony changes on cone-beam computed tomography (CBCT) images of temporomandibular joints (TMJs). Methods Two hundred eighty-three temporomandibular joints with degenerative bony changes were evaluated. Pain intensity (numeric rating scale, NRS) and pain duration in patients with degenerative joint disease (DJD) were also analyzed. We classified condylar bony changes on CBCT into five types: osteophyte (Osp), erosion (Ero), flattening (Fla), subchondral sclerosis (Scl), and pseudocyst (Pse). Results Degenerative bony changes were the most frequent in the age groups of 10~19, 20–29, and 50~59 years. The most frequent pain intensity was “none” (NRS 0, 34.6%) followed by “annoying” (NRS 3–5, 29.7%). The most frequent condylar bony change was Fla (219 joints, 77.4%) followed by Ero (169 joints, 59.7%). “Ero + Fla” was the most common combination of the bony changes (12.7%). The frequency of erosion was directly proportional to NRS, but the frequency of osteophyte was inversely proportional. The prevalence of Ero increased from onset until 2 years and gradually decreased thereafter. The prevalence of Osp, Ero, and Pse increased with age. Conclusions Osp and Ero can be pain-related variables in degenerative joint disease (DJD) patients. “Six months to 2 years” may be a meaningful time point from the active, unstable phase to the stabilized late phase of DJD.
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Affiliation(s)
- SunMee Bae
- Department of Oral Medicine and Diagnosis, Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung, 25457 South Korea
| | - Moon-Soo Park
- Department of Oral Medicine and Diagnosis, Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung, 25457 South Korea
| | - Jin-Woo Han
- Department of Oral and Maxillofacial Radiology, Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Young-Jun Kim
- Department of Oral Medicine and Diagnosis, Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, 7 Jukhyun-gil, Gangneung, 25457 South Korea
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Influence of TNF-α-308 G/A gene polymorphism on temporomandibular disorder. Am J Orthod Dentofacial Orthop 2017; 149:692-8. [PMID: 27131251 DOI: 10.1016/j.ajodo.2015.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tumor necrosis factor alpha (TNF-α) levels are significantly upregulated in the synovial fluid of patients with temporomandibular joint disorder (TMD). The TNF-α influences pain generation and maintenance. Therefore, the aim of this study was to investigate the influence of single nucleotide polymorphism TNFA-308 (rs1800629) on TMD risk and on the pressure pain threshold. METHODS The genotypic and allelic frequencies of candidate single nucleotide polymorphisms were compared among 152 TMD patients and 91 sex- and age-matched healthy subjects in the control group using the real-time polymerase chain reaction technique. The pressure pain threshold in the temporomandibular joint, anterior fascicle of the temporal muscle, masseter muscle, and Achilles tendon were recorded with an algometer. After the pressure test, all participants received a complete physical examination, including masticatory muscle evaluation, temporomandibular joint palpation, and assessment of mandibular range of motion. RESULTS The TNFA-308 polymorphism is positively associated with TMD. Subjects with TMD had a 2.87 (95% confidence interval, 1.256-6.569) times greater chance of having the GA genotype than did the control group. Rare A-allele homozygotes demonstrated decreased pain sensitivity for the temporomandibular joint and anterior fascicle of the temporal muscle in the pressure pain threshold test compared with ancestral allele homozygotes. CONCLUSIONS This study presents an unprecedented association between the TNFA-308 (rs1800629) polymorphism and TMD. Future studies are needed to enlighten the association between TNFA-308 G/A single nucleotide polymorphism and mechanical pain sensitivity.
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Ernberg M. The role of molecular pain biomarkers in temporomandibular joint internal derangement. J Oral Rehabil 2017; 44:481-491. [DOI: 10.1111/joor.12480] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/21/2022]
Affiliation(s)
- M. Ernberg
- Section for Orofacial Pain and Jaw Function; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- The Scandinavian Center for Orofacial Neurosciences (SCON); Huddinge Sweden
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Durham ZL, Hawkins JL, Durham PL. Tumor necrosis factor-Alpha stimulates cytokine expression and transient sensitization of trigeminal nociceptive neurons. Arch Oral Biol 2016; 75:100-106. [PMID: 27836101 DOI: 10.1016/j.archoralbio.2016.10.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 10/22/2016] [Accepted: 10/31/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Elevated levels of tumor necrosis factor- alpha (TNF-α) in the capsule of the temporomandibular joint (TMJ) are implicated in the underlying pathology of temporomandibular disorders (TMD). TMD are a group of conditions that result in pain in the TMJ and/or muscles of mastication, and are associated with significant social and economic burdens. The goal of this study was to investigate the effect of elevated TNF-α levels in the TMJ capsule on nocifensive behavioral response to mechanical stimulation of trigeminal neurons and regulation of cytokines within the trigeminal ganglion. DESIGN Male Sprague-Dawley rats were injected bilaterally in the TMJ capsule with TNF-α and changes in nocifensive head withdrawal responses to mechanical stimulation of cutaneous tissue directly over the capsule was determined using von Frey filaments. Cytokine levels in trigeminal ganglia were determined by protein array analysis at several time points post injection and correlated to nocifensive behavior. RESULTS TNF-α caused a significant increase in the average number of nocifensive responses when compared to naive and vehicle treated animals 2h post injection, but levels returned to control levels at 24h. Based on array analysis, the levels of eight cytokines were significantly elevated above vehicle control levels at 2h following TNF-α injection, but all eight had returned to the vehicle control levels after 24h. CONCLUSIONS Our findings provide evidence that elevated levels of TNF-α in the joint capsule, which is reported to occur in TMD, promotes nociception in trigeminal ganglia neurons via a mechanism that temporally correlates with differential regulation of several cytokines.
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Affiliation(s)
- Zachary L Durham
- Missouri State University, JVIC-CBLS, 524 North Boonville Avenue, Springfield, MO 65806, United States.
| | - Jordan L Hawkins
- Missouri State University, JVIC-CBLS, 524 North Boonville Avenue, Springfield, MO 65806, United States.
| | - Paul L Durham
- Missouri State University, JVIC-CBLS, 524 North Boonville Avenue, Springfield, MO 65806, United States.
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Kartha S, Zhou T, Granquist EJ, Winkelstein BA. Development of a Rat Model of Mechanically Induced Tunable Pain and Associated Temporomandibular Joint Responses. J Oral Maxillofac Surg 2016; 74:54.e1-10. [DOI: 10.1016/j.joms.2015.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 11/24/2022]
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Relationship Between Activity of Gluthatione Peroxidase and Nitric Oxide in Synovial Fluid and the Progression of Temporomandibular Joint Internal Derangement. J Craniofac Surg 2015; 26:e210-3. [DOI: 10.1097/scs.0000000000001435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Ahmed N, Petersson A, Catrina AI, Mustafa H, Alstergren P. Tumor necrosis factor mediates temporomandibular joint bone tissue resorption in rheumatoid arthritis. Acta Odontol Scand 2015; 73:232-40. [PMID: 25515682 DOI: 10.3109/00016357.2014.994561] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate if TNF, IL-1 or their endogenous controls, in relation to ACPA, are associated with radiological signs of ongoing temporomandibular joint (TMJ) bone tissue resorption and disc displacement in RA patients. METHODS Twenty-two consecutive outpatients with TMJ of RA were included. Systemic inflammatory activity was assessed by DAS28. The number of painful regions in the body and ESR, CRP, RF and ACPA were analyzed. TMJ synovial fluid and blood samples were obtained and analyzed for TNF, TNFsRII, IL-1ra, IL-1sRII and ACPA. The ratios between the mediators and their endogenous control receptors were used in the statistical analysis. Magnetic resonance imaging was performed in closed- and open-mouth positions and evaluated regarding disc position and presence of condylar and temporal erosions of the TMJ. RESULTS A high TNF level in relation to TNFsRII in TMJ synovial fluid correlated to the degree of TMJ condylar erosion. A high IL-1ra level in relation to TNF in TMJ synovial fluid was also correlated to the degree of TMJ condylar erosion. The total degree of TMJ condylar erosion was correlated with the number of painful regions. CONCLUSION This study indicates that TNF in TMJ synovial fluid mediates TMJ cartilage and bone tissue resorption in RA. The study also suggests that the degree of endogenous cytokine control is of importance for development of bone tissue destruction.
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Affiliation(s)
- Neveen Ahmed
- Department of Dental Medicine, Section for Orofacial Pain and Jaw Function, Karolinska Institutet , Huddinge , Sweden
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Park HN, Kim KA, Koh KJ. Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients. Imaging Sci Dent 2014; 44:293-9. [PMID: 25473637 PMCID: PMC4245471 DOI: 10.5624/isd.2014.44.4.293] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/11/2014] [Accepted: 09/17/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the χ2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05). Conclusion Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.
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Affiliation(s)
- Ha-Na Park
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea
| | - Kyoung-A Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea
| | - Kwang-Joon Koh
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju, Korea
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26
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Tumor necrosis factor-alpha levels in the synovial fluid of patients with temporomandibular joint internal derangement. J Craniomaxillofac Surg 2014; 43:102-5. [PMID: 25465487 DOI: 10.1016/j.jcms.2014.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 10/15/2014] [Accepted: 10/20/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the level of tumor necrosis factor-alpha (TNF-α) in the synovial fluid (SF) of patients with temporomandibular joint (TMJ) internal derangement and to show the relationship between the level of TNF-α and the severity of the disease. MATERIALS AND METHODS Arthrocentesis was performed on 32 female and five male patients (aged between 17 and 45) referred to our clinic with the complaint of TMJ pain and discomfort. TNF-α levels were determined in the SF samples obtained during arthrocentesis. As a measure of pain, visual analog scale (VAS) scores were also evaluated. RESULTS There were statistically significant differences in VAS scores between the stages. VAS scores were found to be elevated as the stage of disease progressed. Increased levels of TNF-α were found in progressive stages of internal derangement. CONCLUSION In our study, both SF TNF-α levels and pain levels (VAS scores) were found to be increased in patients with internal derangement as the stage of the disease progresses. TNF-α might contribute to the pathogenesis of synovitis and the degeneration of the TMJ cartilage and bone.
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Wang XD, Cui SJ, Liu Y, Luo Q, Du RJ, Kou XX, Zhang JN, Zhou YH, Gan YH. Deterioration of mechanical properties of discs in chronically inflamed TMJ. J Dent Res 2014; 93:1170-6. [PMID: 25266714 DOI: 10.1177/0022034514552825] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Temporomandibular joint (TMJ) discs frequently undergo degenerative changes in arthritis. However, the biomechanical properties of pathogenic discs remain to be explored. In this study, we evaluated the effects of chronic inflammation on the biomechanical properties of TMJ discs in rats. Chronic inflammation of TMJs was induced by double intra-articular injections of complete Freund's adjuvant for 5 weeks, and biomechanical properties and ultrastructure of the discs were examined by mechanical testing, scanning electron microscopy, and transmission electron microscopy. The instantaneous compressive moduli of the anterior and posterior bands of discs in inflamed TMJs were decreased significantly compared with those in the control group. The instantaneous tensile moduli of the discs of inflamed TMJs also showed significant decreases in both the anterior-posterior and mesial-lateral directions. The relaxation moduli of the discs of inflamed TMJs showed nearly the same tendency as the instantaneous moduli. The surfaces of the discs of inflamed TMJs became rough and porous due to the loss of the superficial gel-like stratum, with many collagen fibers exposed and degradation of the sub-superficial collagen fibrils. Our results suggested that chronic inflammation of TMJ could lead to deterioration of mechanical properties and alteration of disc ultrastructure, which might contribute to TMJ disc displacement.
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Affiliation(s)
- X D Wang
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - S J Cui
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - Y Liu
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - Q Luo
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - R J Du
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - X X Kou
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - J N Zhang
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - Y H Zhou
- Department of Orthodontics Center for Craniofacial Stem Cell Research and Regeneration
| | - Y H Gan
- Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing 100081, China
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The influence of altered occlusion on pro-inflammatory cytokine levels in the TMJ synovial tissues of rats. Arch Oral Biol 2014; 59:1164-71. [PMID: 25103542 DOI: 10.1016/j.archoralbio.2014.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/17/2014] [Accepted: 07/13/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether altered occlusion affects both the condylar cartilage thickness and the cytokine levels of the TMJs of rats. DESIGN Thirty adult-male rats (n=30) were randomly assigned to three experimental conditions: a control group that underwent sham operations with unaltered occlusion; an FPDM group that underwent functional posterior displacement of the mandible that was induced by an incisor guiding appliance; and an iOVD group in which the increased occlusal vertical dimension was induced in the molars. The rats were subjected to the FPDM or iOVD model for 14 days and then killed. Both the right and left TMJs were removed and randomly assigned to examination with staining or immunoassay techniques. Toluidine blue staining was used to measure the thicknesses of the four layers of the articular cartilage (i.e., the fibrous, proliferating, mature, and hypertrophic layers). ELISA assays were used to assess the concentrations of the pro-inflammatory cytokines IL-1α, IL-1β, IL-6, and tumour necrosis factor (TNF-α). The measurements of the articular cartilage layers and cytokine concentrations were analyzed with ANOVA and Tukey's tests and Kruskal-Wallis and Dunn tests, respectively (α=5%). RESULTS The thickness of articular cartilage in the FPDM group (0.3±0.03mm) was significantly greater than those of the control (0.2±0.01mm) and iOVD (0.25±0.03mm) groups. No significant difference was observed between the control and iOVD groups. The four articular cartilage layers were thicker in the FPDM group than in the control and iOVD groups, and the latter two groups did not differ one from each other. Both the FPDM and iOVD groups exhibited higher cytokine levels than did the control (p<0.05) group. Compared to the FPDM group, the iOVD group exhibited significantly higher levels of IL-1β and TNF-α. CONCLUSION Both models induced inflammation in the TMJ and caused significant structural changes in the TMJ and surrounding tissues.
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Singh S, Varghese D. Single puncture arthrocentesis of temporomandibular joint; introducing a novel device: A pilot study. Natl J Maxillofac Surg 2014; 4:193-7. [PMID: 24665175 PMCID: PMC3961894 DOI: 10.4103/0975-5950.127650] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Arthrocentesis is a method of irrigating the temporomandibular joint (TMJ) with a therapeutic substance. It is usually performed by dual puncture with two needles to the joint space. Several studies have shown that arthrocentesis of the upper compartment of the TMJ may be a highly effective method to restore normal maximal mouth opening and functioning. Nonetheless, the classical two needle technique has some limitations, such as the low tolerability and difficulty in performing it in the presence of intra-articular adherences. The adoption of a single puncture technique for both fluid injection and aspiration might have some advantages with respect to the traditional two needle approach in terms of time of execution, tolerability, and retention of medication. MATERIALS AND METHODS A single puncture technique with a self fabricated device is used to assess the efficacy of this device. This study involved 20 patients of age ranging between 20- 64 years diagnosed with TMD. Patients follow up done at 3(rd), 14(th), 45(th) and 90(th) day and assessment of pain, mouth opening, clicking and deviation done with comparison of pre and post-operative data. RESULTS The procedure was successful in all the patients. Most of the patients reported reduction in pain more than half of the previous value and two patients reported only moderate reduction. There was a clinically significant improvement in mouth opening, clicking and deviation. CONCLUSION Arthrocentesis is effective in treating TMJ internal derangement and restoring its function. Single puncture arthrocentesis, is a minimally invasive, simple, inexpensive & highly efficient procedure that can be performed under local anaesthesia.
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Affiliation(s)
- Sourav Singh
- Department of Oral and Maxillofacial Surgery, Darshan Dental College and Hospital, Udaipur, India
| | - Don Varghese
- Department of Oral and Maxillofacial Surgery, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
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Etőz OA, Erdal ME, Herken H, Bayazit YA, Mutlu MN. Lack of association between the 308GA polymorphism of the tumor necrosis factor alpha gene and temporomandibular dysfunction. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856906776760443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Tvrdy P, Heinz P, Pink R. Arthrocentesis of the temporomandibular joint: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 159:31-4. [PMID: 23579112 DOI: 10.5507/bp.2013.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 04/03/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Arthrocentesis is a very gentle method for lavage of the joint space. The principle consists in the introduction of a pair of needles into the upper joint space and subsequent lavage using physiological saline or Ringer's solution. Arthrocentesis of the temporomandibular joint is used in both cases of acute closed lock and treatment of various temporomandibular disorders. METHODS A literature search in Pubmed database, using key words: Temporomandibular joint (TMJ), Arthrocentesis, indications, technique, results. CONCLUSION Arthrocentesis of the temporomandibular joint is a minimally invasive treatment method at the boundary between conservative and surgical therapy. It is usually performed on an out-patient basis under local anaesthesia. It is used both in cases of acute block caused by displacement of the articular disc and also to treat degenerative inflammatory diseases of the joints. The main objective of arthrocentesis is to wash out inflammatory mediators, release the disc, break adhesions, eliminate pain and improve joint mobility. It is a method with a minimum number of complications, it is simple and not demanding in terms of instruments, and it can be performed repeatedly. For this reason, it has become widespread and very popular in the treatment of internal disorders of the temporomandibular joint.
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Affiliation(s)
- Peter Tvrdy
- Department of Oral and Maxillofacial Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Eberhard L, Giannakopoulos NN, Rohde S, Schmitter M. Temporomandibular joint (TMJ) disc position in patients with TMJ pain assessed by coronal MRI. Dentomaxillofac Radiol 2013; 42:20120199. [PMID: 23503807 DOI: 10.1259/dmfr.20120199] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To assess the position of the temporomandibular joint (TMJ) disc in patients with TMJ pain and compare it with equivalent published data of asymptomatic volunteers. METHODS The oblique coronal closed- and open-jaw MR images from 66 patients with TMJ pain were evaluated. Clinical examination followed the research diagnostic criteria for temporomandibular disorders. In all coronal images, the transverse condylar axis and the medial and lateral edges of the disc were determined using special software. Inter-rater agreement was calculated [two raters; inter-rater correlation coefficient (ICC)]. The presence of osteoarthrosis (OA) was determined by two independent raters. The influence of OA was estimated in patients (generalized estimation equation model). The results were compared with those of healthy volunteers (t-test). Differences between closed and open jaw in patients were analysed with the Wilcoxon matched-pair test. RESULTS The ICC was good for the transverse condylar axis (0.987) and the medial edge of the disc (0.799) and fair for the lateral edge (0.355). On average, the disc projected 5.5% to the medial side; laterally, the condyle was partially uncovered by the disc (-16.6%). In the open-jaw position, both the medial and the lateral edges shifted medially (to 17.6% vs -23.6%, Wilcoxon matched-pair test, p < 0.001). OA had no significant influence (generalized estimation equation model, p = 0.952). The disc position differed significantly from asymptomatic individuals (t-test, p < 0.001) who showed a medial disc position and full coverage of the condyle. CONCLUSIONS In patients with TMJ pain, the disc seems to be smaller and located less medially than in healthy volunteers. The extent of the medial shift on opening was similar.
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Affiliation(s)
- L Eberhard
- Department of Prosthodontics, University of Heidelberg, Germany.
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Pimenta e Silva Machado L, de Macedo Nery MB, de Góis Nery C, Leles CR. Profiling the clinical presentation of diagnostic characteristics of a sample of symptomatic TMD patients. BMC Oral Health 2012; 12:26. [PMID: 22857609 PMCID: PMC3500225 DOI: 10.1186/1472-6831-12-26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 07/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients' clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. METHODS Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. RESULTS The most common diagnoses were localized masticatory muscle pain (n = 125) and disc displacement without reduction (n = 104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n = 36), acute muscle pain (n = 125), acute articular pain (n = 75) and chronic articular impairment (n = 121). CONCLUSION Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.
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Gunson MJ, Arnett GW, Milam SB. Pathophysiology and Pharmacologic Control of Osseous Mandibular Condylar Resorption. J Oral Maxillofac Surg 2012; 70:1918-34. [DOI: 10.1016/j.joms.2011.07.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/11/2011] [Accepted: 07/12/2011] [Indexed: 01/01/2023]
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Monje-Gil F, Nitzan D, González-Garcia R. Temporomandibular joint arthrocentesis. Review of the literature. Med Oral Patol Oral Cir Bucal 2012; 17:e575-81. [PMID: 22322493 PMCID: PMC3476018 DOI: 10.4317/medoral.17670] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 06/26/2011] [Indexed: 11/05/2022] Open
Abstract
The treatment of the temporomandibular joint (TMJ) is still controversial. TMJ arthrocentesis represents a form of minimally invasive surgical treatment in patients suffering from internal derangement of the TMJ, especially closed lock. It consists of washing the joint with the possibility of depositing a drug or other therapeutic substance. Resolution of symptoms is due to the removal of chemical inflammatory mediators and changes in intra-articular pressure. Numerous clinical studies regarding this technique have been published. The goal of this paper is to review all clinical articles that have been published with regard to the critique of this technique. 19 articles with different designs fulfilling selection guidelines were chosen. A series of clinical and procedure variables were analyzed. Although the mean of improvement was higher that 80%, further research is needed to determine more homogeneous indications for TMJ athrocentesis.
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Affiliation(s)
- Florencio Monje-Gil
- Department of Oral and Maxillofacial Surgery, University Hospital Infanta Cristina, Private practice, Spain.
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Machoň V, Sedý J, Klíma K, Hirjak D, Foltán R. Arthroscopic lysis and lavage in patients with temporomandibular anterior disc displacement without reduction. Int J Oral Maxillofac Surg 2011; 41:109-13. [PMID: 21885248 DOI: 10.1016/j.ijom.2011.07.907] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 05/08/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
Abstract
The authors prospectively analysed 50 patients with chronic anterior disc displacement without reduction, who underwent arthroscopic lysis and lavage of the temporomandibular joint (TMJ). Patients with symptoms lasting less than 1 year were assigned to Group A (n=28) and patients with symptoms lasting more than 1 year to Group B (n=22). The most common problems were inflammatory changes of synovial and retrodiscal tissue (Group A, 71%; Group B, 82%). Fibrous adhesions were present in 14% of Group A patients and 45% of Group B patients. Degenerative changes of the disc and articular surface were present in 4% of Group A patients and 32% of Group B patients. Mouth opening increased 123% from baseline in Group A, and 112% in Group B (P<0.05). Pain decreased significantly in both groups (Group A, 2.5 points; Group B, 1.68 points; P<0.05). In conclusion, almost all patients with chronic anterior disc displacement without reduction benefited from arthroscopic lysis and lavage of the TMJ. Patients with a shorter duration of symptoms problems benefited more than those with a longer duration. Arthroscopic lysis and lavage of the TMJ is safe and beneficial in chronic anterior disc displacement without reduction.
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Affiliation(s)
- V Machoň
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Machon V, Hirjak D, Lukas J. Therapy of the osteoarthritis of the temporomandibular joint. J Craniomaxillofac Surg 2011; 39:127-30. [DOI: 10.1016/j.jcms.2010.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 03/27/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022] Open
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MANFREDINI D, BUCCI MB, MONTAGNA F, GUARDA-NARDINI L. Temporomandibular disorders assessment: medicolegal considerations in the evidence-based era. J Oral Rehabil 2010; 38:101-19. [DOI: 10.1111/j.1365-2842.2010.02131.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Lee JK, Cho YS, Song SI. Relationship of Synovial Tumor Necrosis Factor α and Interleukin 6 to Temporomandibular Disorder. J Oral Maxillofac Surg 2010; 68:1064-8. [DOI: 10.1016/j.joms.2009.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 08/18/2009] [Indexed: 11/28/2022]
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Temporomandibular joint pain and synovial fluid analysis: a review of the literature. J Oral Maxillofac Surg 2009; 67:2497-504. [PMID: 19837323 DOI: 10.1016/j.joms.2009.04.103] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 04/23/2009] [Indexed: 02/06/2023]
Abstract
The pathophysiology of temporomandibular joint pain is not well understood. A significant amount of research has been conducted to evaluate synovial fluid in these patients and in healthy controls. Qualitative and quantitative analyses of the synovial fluid have shown a significant difference between these groups. A multitude of inflammatory mediators and degradation products have been identified. The concentration of these products has been shown to correlate with several clinical parameters including pain, chronicity, severity of degenerative change, and response to treatment. A common inflammatory pathway would appear to be involved in most patients. At the present time, synovial fluid analysis does not have the sensitivity or specificity to allow specific diagnoses and targeted treatment. Continued research with the specific aim of establishing more appropriate therapeutic modalities based on the biochemical pathways is warranted.
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Gulen H, Ataoglu H, Haliloglu S, Isik K. Proinflammatory cytokines in temporomandibular joint synovial fluid before and after arthrocentesis. ACTA ACUST UNITED AC 2009; 107:e1-4. [DOI: 10.1016/j.tripleo.2009.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 01/12/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
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Doom M, de Bruin T, de Rooster H, van Bree H, Cox E. Immunopathological mechanisms in dogs with rupture of the cranial cruciate ligament. Vet Immunol Immunopathol 2008; 125:143-61. [DOI: 10.1016/j.vetimm.2008.05.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 05/06/2008] [Accepted: 05/19/2008] [Indexed: 01/24/2023]
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Khan AA, Diogenes A, Jeske NA, Henry MA, Akopian A, Hargreaves KM. Tumor necrosis factor alpha enhances the sensitivity of rat trigeminal neurons to capsaicin. Neuroscience 2008; 155:503-9. [PMID: 18582539 DOI: 10.1016/j.neuroscience.2008.05.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 05/05/2008] [Accepted: 05/07/2008] [Indexed: 01/12/2023]
Abstract
Tumor necrosis factor alpha (TNFalpha), a pro-inflammatory cytokine, enhances the development of pain and hyperalgesia, although the molecular mechanisms are not well understood. This study evaluated the hypothesis that TNFalpha increases the sensitivity of rat trigeminal neurons to capsaicin via two different mechanisms triggered by either brief or sustained exposure to the cytokine. A brief (5 min) application of TNFalpha significantly sensitized capsaicin-evoked accumulation of intracellular calcium ([Ca2+]i) (226.4+/-37.7 nM vs. 167.5+/-31.3 nM) and increased capsaicin-evoked nocifensive behavior (78.3+/-9.7 vs. 30.9+/-3.6 s) as compared with vehicle pretreatment (P<0.01 for both). Sustained (30 min to 4 h) exposure of cultured neurons to TNFalpha evoked a twofold increase in mRNA transcript (P<0.05) and protein levels (P<0.01) of transient potential receptor vanilloid type 1 (TRPV1). This long-term up-regulation of TRPV1 expression by TNFalpha correlated with enhancement in capsaicin-induced calcitonin gene-related peptide release (P<0.05). Demonstration of colocalization of TNFalpha receptor subtypes I and II with TRPV1 in almost all (>90%) TRPV1 expressing neurons provides evidence consistent with a direct interaction on the same subpopulation of sensory neurons. In summary, our data demonstrate that TNFalpha directly enhances the sensitivity of rat trigeminal neurons to capsaicin via both rapid, non-genomic mechanisms as well as sustained genomic regulation in TRPV1 expression. Thus, increased sensitization and up-regulation of TRPV1 constitutes a potential mechanism by which TNFalpha mediates inflammatory hyperalgesia and pain.
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Affiliation(s)
- A A Khan
- Department of Endodontics, MC 7892, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Mejersjö C, Wenneberg B. Diclofenac sodium and occlusal splint therapy in TMJ osteoarthritis: a randomized controlled trial. J Oral Rehabil 2008; 35:729-38. [PMID: 18482350 DOI: 10.1111/j.1365-2842.2008.01863.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of the study was to compare treatment with diclofenac sodium (Voltaren 3 x 50 mg) to occlusal splint therapy in a randomized, single-blind controlled trial of patients with a diagnosis of temporomandibular joint (TMJ) osteoarthritis (OA) in accordance with Research Diagnostic Criteria for temporomandibular disorders. Patients with general joint disorders or restrictions against medication with non-steroidal anti-inflammatory drug were not included. Twenty-seven females and two males (aged 36-76 years) included, answered a standardized questionnaire and were clinically examined and they underwent TMJ tomography. The treatment was randomized to either splint (n = 15) or diclofenac (n = 14). The temperatures over the TMJs were determined. The patients were re-examined 1 week, 1 month and 3 months after the start of treatment. A 1-year follow-up was carried out using questionnaires. After 1 week of treatment with diclofenac, significant reductions of pain and discomfort, TMJ tenderness and joint pain on jaw movements were noted. The splint therapy gave a significant reduction of reported symptoms after 1 month of treatment. Both treatments gave few adverse effects and were on an equal level. Estimation of the degree of inflammation by measuring the surface temperature over the TMJ was not reliable. Structural changes of the symptomatic TMJs were radiographically found in 82%, the contralateral, symptom-free TMJ had changes in 36%. There was a discrepancy between the clinical and the radiographical findings. Diclofenac gave a more rapid improvement, but both treatments gave a significant reduction of symptoms of TMJ OA within 3 months which remained at the one-year follow-up.
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Affiliation(s)
- C Mejersjö
- Clinic of Orofacial Pain, Community Dentistry of Göteborg, Göteborg Uninversity, Göteborg, Sweden.
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Lin PW, Liu RS, Liou TH, Pan LC, Chen CH. Correlation between joint [F-18] FDG PET uptake and synovial TNF-α concentration: A study with two rabbit models of acute inflammatory arthritis. Appl Radiat Isot 2007; 65:1221-6. [PMID: 17709251 DOI: 10.1016/j.apradiso.2007.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 06/10/2007] [Accepted: 06/10/2007] [Indexed: 11/25/2022]
Abstract
The objective of this study was to verify that the [F-18]FDG PET synovial uptake is correlated with the synovial fluid (SF) TNF-alpha concentration. Two rabbit models of acute inflammatory arthritis induced by human interleukin-8 and lipopolysaccharide were used. Modified standard uptake values (MSUVs) obtained from PET images of the animals were compared with results of SF TNF-alpha measurements. Statistically significant correlations were found between the MSUVs and the SF TNF-alpha ratios. An equation to estimate the TNF-alpha ratio from a MSUV was also derived.
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Affiliation(s)
- Po-Wei Lin
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, 111 Hsing-Long Road Sec. 3, Taipei 11696, Taiwan
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Al-Belasy FA, Dolwick MF. Arthrocentesis for the treatment of temporomandibular joint closed lock: a review article. Int J Oral Maxillofac Surg 2007; 36:773-82. [PMID: 17582743 DOI: 10.1016/j.ijom.2007.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Accepted: 04/30/2007] [Indexed: 11/18/2022]
Abstract
Although arthrocentesis is not a panacea, it has been widely used for a variety of temporomandibular joint (TMJ) disorders. Uncritical acceptance of the procedure has been cautioned against, as further analysis and clarification of published studies was required. The aim of this article was to review the efficacy of arthrocentesis in the treatment of patients with TMJ closed lock. The rationale behind this approach was based on the notion that TMJ surgical results should be reported by the specific category of TMJ disorder. After a Medline search of the international literature, 14 articles were found fulfilling the criteria set forth by this article. Another five articles were added after an additional hand search based on the available references of the papers found. The majority of the reviewed publications were prospective case series with flawed methodology and, despite the impression that arthrocentesis may be beneficial for patients with TMJ closed lock, there have been no good prospective randomized clinical trials that confirm the efficacy of this procedure.
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Affiliation(s)
- F A Al-Belasy
- Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Ting E, Roveroni RC, Ferrari LF, Lotufo CMC, Veiga MCFA, Parada CA, Tambeli CH. Indirect mechanism of histamine-induced nociception in temporomandibular joint of rats. Life Sci 2007; 81:765-71. [PMID: 17706725 DOI: 10.1016/j.lfs.2007.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 07/02/2007] [Accepted: 07/17/2007] [Indexed: 10/23/2022]
Abstract
A considerable amount of evidence suggests that temporomandibular joint (TMJ) pain associated with temporomandibular disorder results, at least in part, from an inflammatory episode. Although histamine can cause pain, it is not clear whether this mediator induces nociception in the TMJ. In this study, we investigated the contribution of endogenous histamine to formalin-induced nociception in the TMJ of rats. We also investigated whether the administration of histamine induces nociception in the TMJ and, if so, whether this effect is mediated by an indirect action on primary afferent nociceptors. Local administration of the H1-receptor antagonist pyrilamine prevented formalin-induced nociception in the TMJ in a dose-dependent manner. Local administration of histamine (250 microg) in the TMJ induced nociceptive behavior that was inhibited by co-administration of the lidocaine N-ethyl bromide quaternary salt QX-314 (2%) or the selective H1-receptor antagonist pyrilamine (400 microg). Nociception induced by histamine was also inhibited by pre-treatment with sodium cromoglycate (800 microg) and by co-administration of the 5-HT(3) receptor antagonist tropisetron (400 mug), while pyrilamine (400 mug) did not inhibit nociception induced by 5-hydroxytryptamine (5-HT, 250 microg) in the TMJ. Furthermore, histamine, in a dose that did not induce nociception by itself, strongly enhanced 5-HT-induced nociception. Finally, the administration of a sub-threshold dose of 5-HT (100 microg), but not of histamine (100 microg), elicited nociception in the TMJ previously challenged with the inflammatory agent carrageenan (100 microg). In conclusion, these data suggest that histamine induces TMJ nociception by an indirect mechanism involving endogenous release of 5-HT and activation of 5-HT(3) receptors on sensory afferents. It is proposed that histamine activates the H1 receptor to induce the release of 5-HT which depolarizes the nociceptor by activating 5-HT(3) receptor.
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Affiliation(s)
- Elizabeth Ting
- Department of Physiology, Faculty of Dentistry of Piracicaba, University of Campinas, Brazil
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Matsumoto K, Honda K, Ohshima M, Yamaguchi Y, Nakajima I, Micke P, Otsuka K. Cytokine profile in synovial fluid from patients with internal derangement of the temporomandibular joint: a preliminary study. Dentomaxillofac Radiol 2007; 35:432-41. [PMID: 17082335 DOI: 10.1259/dmfr/77288976] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Temporomandibular joint disorders (TMD) comprise a group of chronic painful conditions of mastication in the temporomandibular joint (TMJ). Although the association between TMD and internal derangement of the TMJ is well documented, the functional relevance is still unclear. Increased concentrations of inflammatory mediators have been identified in the synovial fluid of affected patients with TMD, suggesting an underlying degenerative or inflammatory process. The aim of this study was to generate a comprehensive cytokine expression profile in TMD. METHODS 15 samples from patients with internal derangement of TMJ were analysed using a novel cytokine array that enables the analysis of 79 different cytokines simultaneously. RESULTS Cytokine levels were correlated with the presence of joint effusion (JE) determined by MRI. In the majority of synovial fluid samples, angiogenin (Ang), fibroblast growth factor (FGF)-9, insulin-like growth factor-binding protein (IGFBP)-3, interleukin (IL)-1alpha, IL-1beta, IL-8, inducible protein (IP)-10, macrophage inflammatory protein (MIP)-1beta, osteoprotegerin (OPG), transforming growth factor (TGF)-beta2, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, tumour necrosis factor (TNF)-beta and vascular endothelial growth factor (VEGF) were detectable. Furthermore, the expression levels of Ang, brain-derived neurotrophic factor (BDNF), FGF-4, FGF-9, IGFBP-2, IL-8, MIP-1beta, OPG, pulmonary and activation-regulated protein (PARC), TGF-beta2, TIMP-2 and VEGF were significantly associated with the presence of JE; among these, nine cytokines (Ang, BDNF, FGF-4, FGF-9, IGFBP-2, MIP-1beta, PARC, TGF-beta2 and TIMP-2) were hitherto not described in TMD. CONCLUSIONS This study confirmed previous reports of elevated cytokine levels in TMD. Additionally, we identified previously undescribed cytokines that were upregulated and correlated significantly with the presence of JE. We were able to identify novel cytokines that have hitherto not been described in TMD. Strategies targeting the identified cytokines may represent a novel therapy option in TMD.
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Affiliation(s)
- K Matsumoto
- Department of Radiology, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
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Nagai H, Miyamoto Y, Nakata A, Hatakeyama S, Iwanami Y, Fukuda M. Isolation and characterization of synovial cells from the human temporomandibular joint. J Oral Pathol Med 2006; 35:104-10. [PMID: 16430741 DOI: 10.1111/j.1600-0714.2006.00369.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The synovial tissues with temporomandibular disorders (TMDs) often show chronic inflammatory changes and the synovial cells participate in the pathogenic processes of TMDs. The synovial membrane is composed of a synovial lining layer and a connective sublining layer. The synovial lining layer is made up of two kinds of cells: macrophage-like type A and fibroblastic type B cells. The aim of this study was to isolate and characterize synovial cells from the human temporomandibular joint (TMJ). METHODS Synovial cells were isolated using an explant culture method. Then, we characterized the cultured synovial cells (SGA2 cells) using immunocytochemistry. RESULTS SGA2 cells expressed the fibroblastic markers vimentin and prolyl 4-hydroxylase; they also expressed laminin and heat shock protein 27, all of which are markers of type B cells. However, some cells expressed the macrophage marker CD68. These CD68-positive cells simultaneously expressed laminin. CONCLUSIONS We isolated and cultured synovial type B cells from the human TMJ, and identified the presence of intermediate type synovial lining cells, having the phenotypic properties of both type A and type B cells, among the synovial lining cells.
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Affiliation(s)
- H Nagai
- Division of Dentistry and Oral Surgery, Akita University Hospital, Akita, Japan.
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Fujimura K, Kobayashi S, Yoshitake Y, Tsuruoka N, Kaneyama K, Segami N. Electrophoretically separation of the synovial fluid proteins in rabbit temporomandibular arthritis induced by mechanical loading. J Oral Pathol Med 2005; 34:546-51. [PMID: 16138893 DOI: 10.1111/j.1600-0714.2005.00350.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The concentration of protein in synovial fluid (SF) of temporomandibular joints (TMJs) with disorders tends to be increased. We investigated the protein composition of SF of rabbits in which arthritis of the TMJ was induced. METHOD Arthritis was induced in six TMJs in six rabbits by exertion of a load for 4 weeks. Six non-loaded TMJs in six rabbits served as controls. The protein concentration and content in TMJ SF of the two groups were compared. RESULTS The mean protein concentration was higher in the SF of the loaded group than in that of the non-loaded group (1824 microg/ml vs. 398 microg/ml, P = 0.002). Proteins with molecular weights of more than 95 kDa were abundant in the loaded group (P < 0.05). CONCLUSION Temporomandibular arthritis induced by mechanical loading in rabbit is accompanied by an increase in the abundance of relatively high molecular weight proteins in SF.
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Affiliation(s)
- K Fujimura
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa, Japan.
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