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Abbass MMS, Rady D, El Moshy S, Ahmed Radwan I, Wadan AHS, Dörfer CE, El-Sayed KMF. The Temporomandibular Joint and the Human Body: A New Perspective on Cross Talk. Dent J (Basel) 2024; 12:357. [PMID: 39590407 PMCID: PMC11592717 DOI: 10.3390/dj12110357] [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: 07/20/2024] [Revised: 10/28/2024] [Accepted: 11/04/2024] [Indexed: 11/28/2024] Open
Abstract
Background: As a unique joint that facilitates the articulation of the upper and lower jaws, the temporomandibular joint (TMJ) is concerned with several critical functions, such as speech and mastication. Pain that can become incapacitating is a result of temporomandibular disorders (TMDs), which are complex disorders affecting the masticatory muscles and the TMJ. Several anomalies and TMDs have an interdisciplinary relationship. Complementary and concurrent disorders may be caused by occlusal anomalies, psychological disorders, and changes in spine posture. Methods: This article examines the clinical characteristics of TMDs, their classification, their etiological factors, and the impact of TMJ disorders on the human body with reference to their anatomies and histological structures. Results: The clinical picture of some TMJ pathologies may be unknown, so certain biomarkers, such as cytokines, may be useful for an accurate diagnosis as they are frequently seen in TMJ disorders. Furthermore, novel therapeutic approaches that target pro-inflammatory cytokines and treat TMDs by using tissue engineering and regenerative medicine while permitting TMJ cartilage and bone regeneration may offer numerous benefits that require clinical translation. Conclusions: Implementation of recent modalities such as microvesicles and platelet-rich plasma in growth factors may provide a promising approach to enhance bone formation. In addition, we target different biological markers that give insights into the introduction of new pharmaceutical agents for therapy.
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Affiliation(s)
- Marwa M. S. Abbass
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt; (M.M.S.A.); (D.R.); (S.E.M.); (I.A.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt
| | - Dina Rady
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt; (M.M.S.A.); (D.R.); (S.E.M.); (I.A.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt
| | - Sara El Moshy
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt; (M.M.S.A.); (D.R.); (S.E.M.); (I.A.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt
| | - Israa Ahmed Radwan
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt; (M.M.S.A.); (D.R.); (S.E.M.); (I.A.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt
| | | | - Christof E. Dörfer
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, 43517 Kiel, Germany;
| | - Karim M. Fawzy El-Sayed
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11435, Egypt
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, 43517 Kiel, Germany;
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo 24105, Egypt
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Xu J, Wang D, Yang C, Wang F, Wang M. Reconstructed magnetic resonance image-based effusion volume assessment for temporomandibular joint arthralgia. J Oral Rehabil 2023; 50:1202-1210. [PMID: 37391274 DOI: 10.1111/joor.13551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 03/01/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Joint effusion is often noticed in magnetic resonance image (MRI) and its diagnostic value for arthralgia of the temporomandibular joint (TMJ) remains obscure. OBJECTIVE To develop a method for quantitatively evaluating the joint effusion revealed in MRI and its diagnostic value for arthralgia of the TMJ. METHODS Two-hundreds and twenty-eight TMJs, 101 with arthralgia (Group P) and 105 without (Group NP) from 103 patients, and 22 TMJs (Group CON) from 11 asymptomatic volunteers were examined by using MRI. The effusion volume was measured after constructing a three-dimensional structure of the joint effusion revealed in MRI by using the ITK-SNAP software. The diagnostic capabilities of the effusion volume on arthralgia were evaluated with receiver operating characteristic (ROC) curve analysis. RESULTS Totally 146 joints showed MRI signs of joint effusion, including nine joints from Group CON. However, the medium volume was greater in Group P (66.65 mm3 ), but was much similar in Group CON (18.33 mm3 ) to Group NP (27.12 mm3 ). The effusion volume larger than 38.20 mm3 was validated to discriminate Group P from Group NP. The AUC value was 0.801 (95% CI 0.728 to 0.874), with a sensitivity of 75% and specificity of 78.9%. The median volume of the joint effusion was larger in those with than without bone marrow oedema, osteoarthritis, Type-III disc configurations, disc displacement and higher signal intensity of the retrodiscal tissue (all, p < .05). CONCLUSION The present method for evaluate joint effusion volume well discriminated painful TMJs from non-pain ones.
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Affiliation(s)
- Jiali Xu
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Dongmei Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Chunhua Yang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Fangfang Wang
- Department of Magnetic Resonance, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Meiqing Wang
- Department of stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of TMD, Shanghai Stomatological Disease Centre, Fudan University, Shanghai, China
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Zwiri A, Al-Hatamleh MAI, W. Ahmad WMA, Ahmed Asif J, Khoo SP, Husein A, Ab-Ghani Z, Kassim NK. Biomarkers for Temporomandibular Disorders: Current Status and Future Directions. Diagnostics (Basel) 2020; 10:E303. [PMID: 32429070 PMCID: PMC7277983 DOI: 10.3390/diagnostics10050303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/08/2020] [Indexed: 12/17/2022] Open
Abstract
Numerous studies have been conducted in the previous years with an objective to determine the ideal biomarker or set of biomarkers in temporomandibular disorders (TMDs). It was recorded that tumour necrosis factor (TNF), interleukin 8 (IL-8), IL-6, and IL-1 were the most common biomarkers of TMDs. As of recently, although the research on TMDs biomarkers still aims to find more diagnostic agents, no recent study employs the biomarker as a targeting point of pharmacotherapy to suppress the inflammatory responses. This article represents an explicit review on the biomarkers of TMDs that have been discovered so far and provides possible future directions towards further research on these biomarkers. The potential implementation of the interactions of TNF with its receptor 2 (TNFR2) in the inflammatory process has been interpreted, and thus, this review presents a new hypothesis towards suppression of the inflammatory response using TNFR2-agonist. Subsequently, this hypothesis could be explored as a potential pain elimination approach in patients with TMDs.
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Affiliation(s)
- Abdalwhab Zwiri
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.Z.); (W.M.A.W.A.); (J.A.A.); (A.H.)
| | - Mohammad A. I. Al-Hatamleh
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Wan Muhamad Amir W. Ahmad
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.Z.); (W.M.A.W.A.); (J.A.A.); (A.H.)
| | - Jawaad Ahmed Asif
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.Z.); (W.M.A.W.A.); (J.A.A.); (A.H.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Suan Phaik Khoo
- Department of Oral Diagnostic and Surgical Sciences, School of Dentistry, International Medical University, Bukit Jalil 57000, Kuala Lumpur, Malaysia;
| | - Adam Husein
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.Z.); (W.M.A.W.A.); (J.A.A.); (A.H.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Zuryati Ab-Ghani
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.Z.); (W.M.A.W.A.); (J.A.A.); (A.H.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nur Karyatee Kassim
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (A.Z.); (W.M.A.W.A.); (J.A.A.); (A.H.)
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Hosgor H. The relationship between temporomandibular joint effusion and pain in patients with internal derangement. J Craniomaxillofac Surg 2019; 47:940-944. [DOI: 10.1016/j.jcms.2019.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/28/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022] Open
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Otonari-Yamamoto M, Imoto K. Differences in signal intensities of temporomandibular joint (TMJ) effusion on fluid-attenuated inversion recovery (FLAIR) images. Oral Radiol 2018; 34:245-250. [DOI: 10.1007/s11282-018-0317-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
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Ngamsom S, Nakamura S, Sakamoto J, Kotaki S, Tetsumura A, Kurabayashi T. The intravoxel incoherent motion MRI of lateral pterygoid muscle: a quantitative analysis in patients with temporomandibular joint disorders. Dentomaxillofac Radiol 2017; 46:20160424. [PMID: 28332854 DOI: 10.1259/dmfr.20160424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To quantitatively evaluate diffusion and perfusion status of lateral pterygoid muscle (LPM) in patients with temporomandibular joint disorder (TMD) by intravoxel incoherent motion (IVIM) imaging and to correlate with findings on temporomandibular joints (TMJs) by conventional MRI. METHODS 42 patients with TMD underwent MRI. To assess IVIM parameters, diffusion-weighted imaging was obtained by spin-echo-based single-shot echoplanar imaging. Regions of interest were created on all diffusion-weighted images of the superior belly of the lateral pterygoid (SLP) and inferior belly of the lateral pterygoid (ILP) at b-values 0-500 s mm-2. Then, IVIM parameters, diffusion (D) and perfusion (f) were calculated using biexponential fittings. The correlation of these values with conventional MRI findings on TMJs was investigated. RESULTS For SLP, the f parameter in TMJs with anterior disc displacement without reduction was significantly higher than that in normal ones (p = 0.015). It was also significantly higher in TMJs with joint effusion than in those without (p = 0.016). On the other hand, for both SLP and ILP, the D parameter significantly increased in TMJs with osteoarthritis compared with those without (p = 0.015 and p = 0.022, respectively). CONCLUSIONS Pathological changes of LPM in patients with TMD may be quantitatively evaluated by IVIM parameters.
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Affiliation(s)
- Supak Ngamsom
- 1 Oral and Maxillofacial Radiology Department, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,2 Oral and Maxillofacial Radiology Department, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Shin Nakamura
- 1 Oral and Maxillofacial Radiology Department, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Junichiro Sakamoto
- 1 Oral and Maxillofacial Radiology Department, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shinya Kotaki
- 1 Oral and Maxillofacial Radiology Department, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akemi Tetsumura
- 1 Oral and Maxillofacial Radiology Department, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tohru Kurabayashi
- 1 Oral and Maxillofacial Radiology Department, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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7
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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: 3.4] [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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Khawaja SN, Crow H, Mahmoud RFG, Kartha K, Gonzalez Y. Is There an Association Between Temporomandibular Joint Effusion and Arthralgia? J Oral Maxillofac Surg 2016; 75:268-275. [PMID: 27663534 DOI: 10.1016/j.joms.2016.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE The literature on joint effusion (JE) and its association with clinical and radiologic variables in patients with temporomandibular disorders (TMDs) is inconsistent and is characterized by multiple methodologic limitations. The primary aim of this investigation was to evaluate the association between magnetic resonance imaging (MRI) identified JE and temporomandibular joint (TMJ) arthralgia. The secondary aim of this investigation was to determine the association between JE and other clinical and MRI-identified soft tissue characteristics. MATERIALS AND METHODS A retrospective cohort study was conducted. Clinical and soft tissue imaging assessments were carried out according to the Diagnostic Criteria for Temporomandibular Disorders guidelines. The dependent variable was JE and the primary independent variable was arthralgia. The secondary independent variables were TMJ pain-associated characteristics and MRI-identified variables. When applicable, Pearson χ2 or t test was used to determine the statistical associations between JE and clinical characteristics and between JE and MRI-identified variables. Furthermore, generalized estimating equation (GEE) modeling was conducted to determine which of the independent clinical and MRI-identified variables were associated with JE. RESULTS Data for 158 participants, representing 312 joints, were extracted. The mean age of the female sample (59.4%) was 31 ± 11.1 years and that of the male sample (40.6%) was 29.8 ± 9.7 years. No association was found between JE and arthralgia. However, statistically significant associations were found between JE and lateral disc rotation (P = .001) and between JE and disc position in the coronal and sagittal planes (P = .001). The GEE model suggested that disc displacement with reduction (odds ratio = 2.5) was a statistically relevant contributing factor for JE in the absence of degenerative joint disease. CONCLUSION Results associated JE with the position of the disc in the sagittal plane. No association was found between JE and arthralgia or TMJ pain-associated clinical characteristics in patients with TMDs.
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Affiliation(s)
- Shehryar N Khawaja
- Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; Postgraduate Fellow, Harvard School of Dental Medicine, Harvard University, Boston, MA; Former Teaching and Research Fellow, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY.
| | - Heidi Crow
- Associate Professor and Chair, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY
| | - Ruba F G Mahmoud
- Resident, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY
| | - Krishnan Kartha
- Adjunct Assistant Professor, Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY
| | - Yoly Gonzalez
- Associate Professor, Department of Oral Diagnostic Sciences; Director, TMD and Orofacial Pain Program, University at Buffalo, Buffalo, NY
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Tipton DA, Christian J, Blumer A. Effects of cranberry components on IL-1β-stimulated production of IL-6, IL-8 and VEGF by human TMJ synovial fibroblasts. Arch Oral Biol 2016; 68:88-96. [DOI: 10.1016/j.archoralbio.2016.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 01/10/2023]
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Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study. Int J Oral Maxillofac Surg 2016; 45:828-35. [PMID: 26922496 DOI: 10.1016/j.ijom.2016.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/20/2015] [Accepted: 01/29/2016] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the efficacy of injection of plasma rich in growth factors (PRGF) after temporomandibular joint (TMJ) arthroscopy in patients with Wilkes stage IV internal derangement. Ninety-two patients were randomized to two experimental groups: group A (42 joints) received injections of PRGF, group B (50 joints) received saline injections. Pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm) were measured before and after surgery and compared by analysis of variance (ANOVA). The mean age of patients was 35.8 years (range 17-67 years); 86 were female. Significant reductions in pain were noted in both groups after surgery: VAS 7.9 preoperative and 1.4 at 24 months postoperative. Significantly better clinical results were achieved in group A than in group B only at 6 and 12 months postoperative; no significant difference was noted at 18 or 24 months after the surgical intervention. MMO increased after surgery in both groups: 26.2mm preoperative and 36.8mm at 24 months postoperative. No significant differences in MMO were found when the two groups of patients were compared. In conclusion, the injection of PRGF does not add any significant improvement to clinical outcomes at 2 years after surgery in patients with advanced internal derangement of the TMJ.
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Zheng ZW, Yang C, Wang MH, Zhu XH, Fang YM. Non-joint effusion is associated with osteoarthritis in temporomandibular joints with disk displacement. J Craniomaxillofac Surg 2016; 44:1-5. [DOI: 10.1016/j.jcms.2015.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/07/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022] Open
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12
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Cytokine profile in the synovial fluid of patients with temporomandibular joint disorders: A systematic review. Cytokine 2016; 77:98-106. [DOI: 10.1016/j.cyto.2015.11.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 12/22/2022]
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13
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Jung YW, Park SH, On SW, Song SI. Correlation between clinical symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement. J Korean Assoc Oral Maxillofac Surg 2015; 41:125-32. [PMID: 26131429 PMCID: PMC4483526 DOI: 10.5125/jkaoms.2015.41.3.125] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives The purpose of this study was to clarify which findings in magnetic resonance imaging (MRI) are good predicators of pain and mouth opening limitation in patients with temporomandibular joint (TMJ) internal derangement (ID). Materials and Methods Clinical examinations for pain and mouth opening limitation were conducted for suspected TMJ ID. MRI scans were taken within a week of clinical examinations. On the oblique-sagittal plane image, readings were obtained in terms of the functional aspect of disc position, degree of displacement, disc deformity, joint effusion, and osteoarthrosis. Multiple logistic regression analyses were conducted to identify the predictors of pain and mouth opening limitation. Results A total of 48 patients (96 TMJs) were studied, including 39 female patients and 9 male patients whose ages ranged from 10 to 65 years. The resultant data showed significant correlations between pain and the MR imaging of the degree of disc displacement (P<0.05). The probability of there being pain in moderate to significant cases was 9.69 times higher than in normal cases. No significant correlation was found between mouth opening limitation and MRI findings. Conclusion We identified a significant correlation between clinical symptoms and MRI findings of ID. The degree of anterior disc displacement may be useful for predicting pain in patients with TMJ ID.
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Affiliation(s)
- Young-Wook Jung
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
| | - Sung-Hoon Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sung-Woon On
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Il Song
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
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Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients? Am J Orthod Dentofacial Orthop 2014; 146:641-54. [DOI: 10.1016/j.ajodo.2013.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/17/2022]
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Otonari-Yamamoto M, Sano T, Okano T, Wakoh M. Association between osseous changes of the condyle and temporomandibular joint (TMJ) fluid in osteoarthritis. Oral Radiol 2014. [DOI: 10.1007/s11282-014-0185-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tavares R, Beattie KA, Bensen WG, Bobba RS, Cividino AA, Finlay K, Goeree R, Hart LE, Jurriaans E, Larche MJ, Parasu N, Tarride JE, Webber CE, Adachi JD. A double-blind, randomized controlled trial to compare the effect of biannual peripheral magnetic resonance imaging, radiography and standard of care disease progression monitoring on pharmacotherapeutic escalation in rheumatoid and undifferentiated inflammatory arthritis: study protocol for a randomized controlled trial. Trials 2014; 15:268. [PMID: 24997587 PMCID: PMC4227117 DOI: 10.1186/1745-6215-15-268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022] Open
Abstract
Background Permanent joint damage is a major consequence of rheumatoid arthritis (RA), the most common and destructive form of inflammatory arthritis. In aggressive disease, joint damage can occur within 6 months from symptom onset. Early, intensive treatment with conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) can delay the onset and progression of joint damage. The primary objective of the study is to investigate the value of magnetic resonance imaging (MRI) or radiography (X-ray) over standard of care as tools to guide DMARD treatment decision-making by rheumatologists for the care of RA. Methods A double-blind, randomized controlled trial has been designed. Rheumatoid and undifferentiated inflammatory arthritis patients will undergo an MRI and X-ray assessment every 6 months. Baseline adaptive randomization will be used to allocate participants to MRI, X-ray, or sham-intervention groups on a background of standard of care. Prognostic markers, treating physician, and baseline DMARD therapy will be used as intervention allocation parameters. The outcome measures in rheumatology RA MRI score and the van der Heijde-modified Sharp score will be used to evaluate the MRI and X-ray images, respectively. Radiologists will score anonymized images for all patients regardless of intervention allocation. Disease progression will be determined based on the study-specific, inter-rater smallest detectable difference. Allocation-dependent, intervention-concealed reports of positive or negative disease progression will be reported to the treating rheumatologist. Negative reports will be delivered for the sham-intervention group. Study-based radiology clinical reports will be provided to the treating rheumatologists for extra-study X-ray requisitions to limit patient radiation exposure as part of diagnostic imaging standard of care. DMARD treatment dose escalation and therapy changes will be measured to evaluate the primary objective. A sample size of 186 (62 per group) patients will be required to determine a 36% difference in pharmacological treatment escalation between the three groups with intermediate dispersion of data with 90% power at a 5% level of significance. Discussion This study will determine if monitoring RA and undifferentiated inflammatory arthritis patients using MRI and X-ray every 6 months over 2 years provides incremental evidence over standard of care to influence pharmacotherapeutic decision-making and ultimately hinder disease progression. Trial registration This trial has been registered at ClinicalTrials.gov: NCT00808496 (registered on 12 December 2008).
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Affiliation(s)
- Ruben Tavares
- UNCOVER Clinical Research Company, Milton, ON, Canada.
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Yano K, Sano T, Okano T. A Longitudinal Study of Magnetic Resonance (MR) Evidence of Temporomandibular Joint (TMJ) Fluid in Patients with TMJ Disorders. Cranio 2014; 22:64-71. [PMID: 14964339 DOI: 10.1179/crn.2004.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
It has been reported that joint effusion, the excessive accumulation of joint fluid in and around the joint, is related to temporomandibular joint (TMJ) disorders such as pain and disk displacement. However, there have been no longitudinal studies of this phenomenon. We performed a longitudinal study on the relationship between joint fluid and various pathological disk conditions. The subjects were 17 patients who visited our facility for orthodontic treatment and were diagnosed using MRI as having internal derangement of one or both TMJs (three males and 14 females; age 12-31 years; mean age 20.5 years). MRI was performed before, during, or after treatment for their disorders. We evaluated the relationship between changes in joint fluid in the joint space and the state of the disk, as well as the presence or absence of pain. Joint fluid was evaluated by classifying the extent of high-signal areas in the upper and lower articular cavities on T2-weighted images. The extent of high-signal areas was classified into five levels. Disk displacement and the extent of displacement were evaluated using proton density-weighted images. Statistical analysis was performed using the chi-square test, and differences in the distribution among the groups were examined. Effusion was noted on the first MRI in nine of the eleven joints (81.8%) in which joint fluid decreased on the second MRI (p<0.01). Displacement remained unchanged or worsened in 18 of the 21 joints (85.7%) that showed joint fluid on the first MRI (p<0.01). Pain was alleviated or absent in all joints in which the fluid decreased. These results suggest that joint fluid may be a factor in the outcome of disk recapture treatment as well as in the evaluation of pain.
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Affiliation(s)
- Keisuke Yano
- Department of Radiology, Showa University School of Dentistry, Tokyo, Japan
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Al-Baghdadi M, Durham J, Steele J. Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'. J Oral Rehabil 2014; 41:24-58. [PMID: 24393132 DOI: 10.1111/joor.12126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 11/30/2022]
Abstract
Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.
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Affiliation(s)
- M Al-Baghdadi
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Nogami S, Yamauchi K, Kataoka Y, Takano H, Yamashita Y, Takahashi T. Clinical comparison between arthrocentesis and conventional conservative treatment with maxillomandibular fixation for unilateral high condylar fractures. J Oral Rehabil 2013; 41:141-7. [DOI: 10.1111/joor.12124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
- S. Nogami
- Division of Oral and Maxillofacial Surgery; Department of Oral Medicine and Surgery; Tohoku University Graduate School of Dentistry; Aoba-ku Sendai Miyagi Japan
| | - K. Yamauchi
- Division of Oral and Maxillofacial Surgery; Department of Oral Medicine and Surgery; Tohoku University Graduate School of Dentistry; Aoba-ku Sendai Miyagi Japan
| | - Y. Kataoka
- Division of Oral and Maxillofacial Reconstructive Surgery; Department of Oral and Maxillofacial Surgery; Kyushu Dental University; Kokurakita-ku Kitakyushu Fukuoka Japan
| | - H. Takano
- Division of Dentistry and Oral Surgery; Akita University School of Medicine; Akita Japan
| | - Y. Yamashita
- Division of Oral and Maxillofacial Surgery; Department of Sensory and Motor Organs; Faculty of Medicine; Miyazaki University; Miyazaki Japan
| | - T. Takahashi
- Division of Oral and Maxillofacial Surgery; Department of Oral Medicine and Surgery; Tohoku University Graduate School of Dentistry; Aoba-ku Sendai Miyagi Japan
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Schmid-Schwap M, Bristela M, Pittschieler E, Skolka A, Szomolanyi P, Weber M, Piehslinger E, Trattnig S. Biochemical analysis of the articular disc of the temporomandibular joint with magnetic resonance T2 mapping: a feasibility study. Clin Oral Investig 2013; 18:1865-71. [PMID: 24306680 DOI: 10.1007/s00784-013-1154-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Symptoms of temporomandibular joint (TMJ) dysfunction can seriously compromise patients' quality of life. The aim of our study was to use magnetic resonance imaging (MRI) T2 mapping of the articular disc to determine whether T2 mapping of the TMJ disc is feasible in routine clinical imaging and to assess the normal T2 relaxation time distribution within the TMJ. METHODS Included were ten asymptomatic volunteers without pain, any mouth-opening limitations, or any clicking phenomena. MR imaging was performed on a 3-T MR scanner using a flexible, dedicated, eight-channel multielement coil. T2 mapping was performed in the oblique sagittal plane. The regions of interest (ROIs) for the T2 relaxation time maps of the disc were selected manually. RESULTS The mean values for ROIs ranged between 22.4 and 28.8 ms, and the mean for all ROIs was 26.0 ± 5.0 ms. Intraclass correlation (ICC) for interobserver variability was 0.698, and ICC for intraobserver variability was 0.861. There was no statistically significant difference between raters (p = 0.091) or sides (p = 0.810). CONCLUSION The T2 mapping technique enables ultrastructural analysis of the composition of TMJ disc. This biochemical technique is feasible in vivo, as shown in our study, when a high-field (3 T) MR and a dedicated TMJ coil are used. CLINICAL RELEVANCE T2 mapping as a biochemical technique, together with morphological MRI, may help to gain more insights into the physiology and into the pathophysiology of the articular disc in the TMJ noninvasively and in vivo.
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Affiliation(s)
- Martina Schmid-Schwap
- Department of Prosthodontics, Bernhard Gottlieb University of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria,
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Matsumoto K, Kameoka S, Amemiya T, Yamada H, Araki M, Iwai K, Hashimoto K, Honda K. Discrepancy of coronal morphology between mandibular condyle and fossa is related to pathogenesis of anterior disk displacement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:626-32. [PMID: 24012352 DOI: 10.1016/j.oooo.2013.06.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/18/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate whether morphological discrepancy between the mandibular condyle and fossa of the temporomandibular joint (TMJ) is related to disk displacement on magnetic resonance imaging (MRI). STUDY DESIGN This study included 61 patients with unilateral internal derangement based on both MRI and clinical examination. Coronal morphologies of the condyle and fossa were divided into four groups based on Öberg's classification. According to the coronal morphology of the condyle and fossa, all joints were dichotomized into either harmonized group or a discrepancy group (e.g., angled condyle and concave fossa). The incidence of discrepancy and the relationship of the discrepancy to other findings on MRI were statistically evaluated. RESULTS The discrepancy had a significantly higher incidence on the affected side. The discrepancy correlated with incidence of disk deformity on the affected side. CONCLUSION Morphological discrepancy between the condyle and fossa is related to development of anterior disk displacement in the TMJ.
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Affiliation(s)
- Kunihito Matsumoto
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry, Tokyo, Japan.
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Nogami S, Takahashi T, Ariyoshi W, Yoshiga D, Morimoto Y, Yamauchi K. Increased levels of interleukin-6 in synovial lavage fluid from patients with mandibular condyle fractures: correlation with magnetic resonance evidence of joint effusion. J Oral Maxillofac Surg 2013; 71:1050-8. [PMID: 23683296 DOI: 10.1016/j.joms.2013.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/18/2013] [Accepted: 01/18/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the present study was to investigate the relation between magnetic resonance (MR) evidence of joint effusion and concentrations of proinflammatory cytokines, including interleukin (IL)-1β and IL-6, in washed-out synovial fluid samples obtained from patients with mandibular condyle fractures. PATIENTS AND METHODS Twenty-five joints in 23 patients with mandibular condyle fractures were examined. Computed tomography was used to determine the position of the fracture and MR examination was performed in all cases. Twenty-five joints underwent temporomandibular joint (TMJ) irrigation before surgical treatment for the fractures. The detection rates and concentrations of the tested cytokines were determined, and their relations to evidence of joint effusion and positions of the condylar fractures were analyzed. RESULTS Six TMJ fractures were found in the head, 10 in the upper neck, 4 in the lower neck, and 5 in the subcondyle. MR evidence of joint effusion was observed in 17 of 25 TMJs (68.0%). The detection rate and concentration of IL-6 were significantly higher in patients with MR evidence of joint effusion and those with high condylar fractures. Moreover, there was a correlation between joint effusion grade and IL-6 concentration. CONCLUSIONS The present findings showed a correlation between MR evidence of joint effusion and concentration of IL-6 in washed-out synovial fluid samples collected from patients with mandibular condyle fractures. These results may provide support for arthrocentesis as a reasonable treatment modality for high condylar fractures.
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Affiliation(s)
- Shinnosuke Nogami
- Division of Oral and Maxillofacial Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kitakyushu, Japan.
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Hanyuda H, Otonari-Yamamoto M, Imoto K, Sakamoto J, Kodama S, Kamio T, Sano T. Analysis of elements in a minimal amount of temporomandibular joint fluid on fluid-attenuated inversion recovery magnetic resonance images. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:114-20. [DOI: 10.1016/j.oooo.2012.09.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/13/2012] [Accepted: 09/21/2012] [Indexed: 11/30/2022]
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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: 5.5] [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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Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings. J Craniomaxillofac Surg 2012; 40:283-6. [DOI: 10.1016/j.jcms.2011.04.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/15/2011] [Accepted: 04/08/2011] [Indexed: 11/20/2022] Open
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Imoto K, Otonari-Yamamoto M, Nishikawa K, Sano T, Yamamoto A. Potential of fluid-attenuated inversion recovery (FLAIR) in identification of temporomandibular joint effusion compared with T2-weighted images. ACTA ACUST UNITED AC 2011; 112:243-8. [DOI: 10.1016/j.tripleo.2011.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/02/2011] [Accepted: 03/04/2011] [Indexed: 12/24/2022]
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Kaneyama K, Segami N, Yoshimura H, Honjo M, Demura N. Increased levels of soluble cytokine receptors in the synovial fluid of temporomandibular joint disorders in relation to joint effusion on magnetic resonance images. J Oral Maxillofac Surg 2010; 68:1088-93. [PMID: 20149511 DOI: 10.1016/j.joms.2009.10.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 10/16/2009] [Accepted: 10/27/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to clarify the significance of joint effusion (JE) on T2-weighted magnetic resonance images of the temporomandibular joint (TMJ) in comparison to various soluble cytokine receptors in the synovial fluid of patients with temporomandibular disorders (TMDs). PATIENTS AND METHODS Magnetic resonance imaging of 55 TMJs of 55 patients with TMD was performed, and synovial fluid samples were obtained on the same day. The grade of JE was evaluated on a scale from 0 to 3, with grade 0 indicating the absence of JE and grades 1 to 3 indicating the presence of JE. Correlations were measured between JE and the concentrations of soluble tumor necrosis factor receptors I and II, interleukin (IL) 6 soluble receptor, IL-1 soluble receptor type II, and IL-1 receptor antagonist and protein in the synovial fluid samples. RESULTS The mean concentrations of cytokine receptors in the synovial fluid were significantly higher in the 30 joints with JE than in the 25 joints without JE. There were no correlations between the JE grade and the level of any mediators. CONCLUSION Increased levels of cytokine receptors are likely to influence the expression of JE and may play important roles in the pathogenesis of TMD. These results also suggest that JE may reflect synovial inflammation of the TMJ.
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Affiliation(s)
- Keiseki Kaneyama
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa, Japan.
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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: 2.2] [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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Sun W, Dong L, Kaneyama K, Takegami T, Segami N. Bacterial diversity in synovial fluids of patients with TMD determined by cloning and sequencing analysis of the 16S ribosomal RNA gene. ACTA ACUST UNITED AC 2008; 105:566-71. [PMID: 18206402 DOI: 10.1016/j.tripleo.2007.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 08/16/2007] [Accepted: 08/25/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the presence of bacteria in synovial fluids from patients with temporomandibular joint disorder (TMD) by polymerase chain reaction (PCR) targeting the 16S ribosomal RNA (rRNA) gene, followed by cloning and sequencing. STUDY DESIGN Universal bacterial primers were used to amplify 16S rRNA genes in 28 synovial fluid samples from 27 patients with TMD (TMD group) as well as control subjects: 5 patients with dislocation of TMJ (non-TMD group). Subsequently, PCR amplicons were purified and cloned. Partial 16S rRNA sequences of the cloned insert were used to determine the species identities or closest relative by comparison with known sequences using GeneBank. RESULTS Nineteen (67.86%) of 28 samples from patients in the TMD group were identified with the presence of bacterial DNA by PCR. The 5 control samples from the nonTMD group were all negative in this study. After cloning and sequencing, a total of 11 bacterial species was detected, including Granulicatella adiacen (6 samples), Pseudomonas sp. (6 samples), Methylobacterium sp. (5 samples), and Beta proteobacterium (4 samples). Other species, such as Acidovorax sp., Bradyrhizobium sp., Sphingomonas, Streptococcus, Leptothrix sp. oral clone, Thiobacillus denitrificans, and Comamonadaceae bacterium, were also identified. Eight patients were found with mixed bacteria, with 2-4 bacteria per sample. The patients with fastidious bacteria such as Granulicatella adiacen and mixed bacteria were more likely to be older than 45 years (P < .05). CONCLUSION A wide variety of bacteria, including some not previously reported associated with TMD, were identified in the synovial fluids from patients with TMD.
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Affiliation(s)
- Wei Sun
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa, Japan
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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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Kaneyama K, Segami N, Shin-Ichi T, Fujimura K, Sato J, Nagao T. Anchored disc phenomenon with a normally positioned disc in the temporomandibular joint: Characteristics and behaviour. Br J Oral Maxillofac Surg 2007; 45:279-83. [PMID: 17056163 DOI: 10.1016/j.bjoms.2006.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2006] [Indexed: 10/24/2022]
Abstract
We aimed to elucidate the pathogenesis and evaluate the therapeutic behaviour of patients with an anchored disc phenomenon but a normally positioned disc of the temporomandibular joint (TMJ). Fourteen patients with internal derangement including closed lock of one TMJ were examined. All had normally positioned discs. Synovial fluid was collected from the TMJ by arthrocentesis. Their symptoms, and the protein concentration in the synovial fluid, were evaluated. Their median duration of illness was 3 months (range 0.5-12), and the median protein concentration was low (343 microg/ml; range 36-791). Arthrocentesis was successful in nine. Arthroscopic findings in the five unsuccessful cases showed severe intra-articular adhesions of the TMJ. The main intra-articular pathological feature was the presence of adhesions, which might be affected by low protein concentrations in the synovial fluid. These findings may provide a new treatment in patients with normally positioned discs, despite the small number studied.
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Affiliation(s)
- Keiseki Kaneyama
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa-prefecture 920-0293, Japan.
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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: 2.2] [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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Emshoff R, Rudisch A. Temporomandibular Joint Internal Derangement and Osteoarthrosis: Are Effusion and Bone Marrow Edema Prognostic Indicators for Arthrocentesis and Hydraulic Distention? J Oral Maxillofac Surg 2007; 65:66-73. [PMID: 17174766 DOI: 10.1016/j.joms.2005.11.113] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 07/27/2005] [Accepted: 11/23/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has proven to be an effective modality in treating patients exhibiting clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance imaging (MRI) variables of effusion and/or bone marrow edema may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS The study group comprised 37 consecutive patients with TMJ pain, who were assigned a unilateral clinical TMJ disorder of TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction) and a TMJ pain side-related MRI diagnosis of disc displacement without reduction associated with osteoarthrosis (OA). Bilateral sagittal and coronal MRI images were obtained immediately before the operation to establish the presence or absence of ID, OA, TMJ effusion, and bone marrow edema. Pain level and mandibular range of motion (ROM) were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria for success were a ROM >or=35 mm and pain reduction >50%. A logistic regression analysis was used to compute the odds ratio for TMJ effusion and bone marrow edema for successful outcomes (n = 21) versus unsuccessful (n = 16) outcomes. RESULTS At the 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P = .000), a significant reduction in clinical diagnoses of TMJ disorders (P = .016), and a significant increase in ROM (P = .000). A significant increase in the risk of an unsuccessful outcome of ROM <35 mm and/or pain reduction >or=50% occurred with MRI findings of effusion (odds ratio 1:10.8 = 0.09; P = .007). CONCLUSIONS TMJ effusion may prove to be an important prognostic determinant of successful arthrocentesis. However, the data re-emphasize the concept that the prediction of a specific outcome is not a matter of simple linearity, in which the presence of 1 factor may equate with predictive ability, but rather is a function of a complex interaction among different biological variables.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University Clinic Innsbruck, Innsbruck, Austria.
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Alturfan AA, Uslu E, Alturfan EE, Hatemi G, Fresko I, Kokoglu E. Increased Serum Sialic Acid Levels in Primary Osteoarthritis and Inactive Rheumatoid Arthritis. TOHOKU J EXP MED 2007; 213:241-8. [PMID: 17984621 DOI: 10.1620/tjem.213.241] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A. Ata Alturfan
- Vocational School Health Services, Cerrahpasa Medical Faculty, Istanbul University
| | - Ezel Uslu
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University
| | | | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University
| | - Izzet Fresko
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University
| | - Emine Kokoglu
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University
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Lai YC, Shaftel SS, Miller JNH, Tallents RH, Chang Y, Pinkert CA, Olschowka JA, Dickerson IM, Puzas JE, O'Banion MK, Kyrkanides S. Intraarticular induction of interleukin-1beta expression in the adult mouse, with resultant temporomandibular joint pathologic changes, dysfunction, and pain. ACTA ACUST UNITED AC 2006; 54:1184-97. [PMID: 16572453 DOI: 10.1002/art.21771] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the effects of intraarticular induction of interleukin-1beta (IL-1beta) expression in adult mice. METHODS We used somatic mosaic analysis in a novel transgenic mouse with an inducible IL-1beta transcription unit. Transgene activation was induced by Cre recombinase in the temporomandibular joints (TMJs) of adult transgenic mice (conditional knockin model). The effects of intraarticular IL-1beta induction were subsequently evaluated at the cellular, histopathologic, and behavioral levels. RESULTS We developed transgenic mice capable of germline transmission of a dormant transcription unit consisting of the mature form of human IL-1beta as well as the reporter gene beta-galactosidase driven by the rat procollagen 1A1 promoter. Transgene activation by a feline immunodeficiency virus Cre vector resulted in histopathologic changes, including articular surface fibrillations, cartilage remodeling, and chondrocyte cloning. We also demonstrated up-regulation of genes implicated in arthritis (cyclooxygenase 2, IL-6, matrix metalloproteinase 9). There was a lack of inflammatory cells in these joints. Behavioral changes, including increased orofacial grooming and decreased resistance to mouth opening, were used as measures of nociception and joint dysfunction, respectively. The significant increase in expression of the pain-related neurotransmitter calcitonin gene-related peptide (CGRP) in the sensory ganglia as well as the auxiliary protein CGRP receptor component protein of the calcitonin-like receptor in the brainstem further substantiated the induction of pain. CONCLUSION Induction of IL-1beta expression in the TMJs of adult mice led to pathologic development, dysfunction, and related pain in the joints. The somatic mosaic model presented herein may prove useful in the preclinical evaluation of existing and new treatments for the management of joint pathologic changes and pain, such as in osteoarthritis.
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Affiliation(s)
- Yu-Ching Lai
- University of Rochester School of Medicine & Dentistry, Rochester, New York
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Emshoff R, Gerhard S, Ennemoser T, Rudisch A. Magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema before and after performance of arthrocentesis and hydraulic distension of the temporomandibular joint. ACTA ACUST UNITED AC 2006; 101:784-90. [PMID: 16731401 DOI: 10.1016/j.tripleo.2005.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 08/18/2005] [Accepted: 09/09/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate whether temporomandibular joint (TMJ) internal derangement type III and capsulitis/synovitis are related to magnetic resonance imaging (MRI) diagnoses of internal derangement, osteoarthrosis (OA), effusion, and/or bone marrow edema (BME), and whether arthrocentesis is associated with changes in diagnoses of internal derangement, OA, effusion, and/or BME. STUDY DESIGN The study comprised 28 patients with a clinical unilateral TMJ disorder of internal derangement type III and capsulitis/synovitis. Bilateral MRI was immediately performed preoperatively and at a 2-month follow-up. RESULTS There was a significant relationship between TMJ internal derangement type III and capsulitis/synovitis and TMJ internal derangement (P = .000), effusion (P = .036), and BME (P = .002). MRI showed a significant decrease in diagnoses of TMJ BME ((P = .018). CONCLUSIONS MRI variables of internal derangement, effusion, and BME were related to TMJ internal derangement type III and capsulitis/synovitis; however, arthrocentesis was only associated with a significant change in diagnoses of TMJ BME.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillo-Facial Surgery, University Clinic of Innsbruck, Innsbruck, Austria.
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Rhodus NL, Cheng B, Bowles W, Myers S, Miller L, Ondrey F. Proinflammatory cytokine levels in saliva before and after treatment of (erosive) oral lichen planus with dexamethasone. Oral Dis 2006; 12:112-6. [PMID: 16476030 DOI: 10.1111/j.1601-0825.2005.01165.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the potential of detecting the level of proinflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin-1-alpha (IL-1-alpha), IL-6, and IL-8 in whole unstimulated saliva (WUS) in monitoring the therapeutic effects of topical dexamethasone on these salivary cytokines in subjects with erosive oral lichen planus (OLP). STUDY DESIGN Thirteen definitively diagnosed OLP subjects were enrolled in the study as were 13 age- and sex-matched controls. The OLP subjects were treated with 0.1% dexamethasone oral rinse for 6 weeks. Prior to treatment and at the end of clinical trial, the visual analog scale (VAS) for symptoms was recorded, WUS was collected and these proinflammatory cytokines were analyzed by ELISA. RESULTS Following the dexamethasone treatment, the levels of TNF-alpha, IL-1-alpha, IL-6, and IL-8 were decreased significantly, and IL-1-alpha and IL-8 were detected at a level without a statistically significant difference from controls. VAS value was decreased significantly and was found to significantly correlate with the decrease in IL-1-alpha and IL-8 levels. CONCLUSIONS These preliminary results indicate that salivary analysis of NF-kappaB-dependent cytokines may be applied to monitoring the therapeutic response of OLP.
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Affiliation(s)
- N L Rhodus
- Division of Oral Medicine, Department of Diagnostic and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA. rhodu0012umn.edu
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Fujita Y, Hara Y, Nezu Y, Yamaguchi S, Schulz KS, Tagawa M. Direct and indirect markers of cartilage metabolism in synovial fluid obtained from dogs with hip dysplasia and correlation with clinical and radiographic variables. Am J Vet Res 2005; 66:2028-33. [PMID: 16379642 DOI: 10.2460/ajvr.2005.66.2028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare activities of interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, and matrix metalloproteinase (MMP)-3 and contents of sulfated glycosaminoglycan (S-GAG) in joint fluid obtained from dogs with hip dysplasia (HD) and clinically normal dogs, evaluate correlations among these markers in joint fluid obtained from dogs with HD, and evaluate correlations between each marker and clinical and radiographic variables. Animals-26 dogs with HD (clinical group) and 43 clinically normal Beagles (control group). PROCEDURE Joint fluid was aseptically collected from the hip joints of all dogs. For each dog in the clinical group, age, duration of lameness, radiographic osteoarthritis (OA) score, and Norberg angle in each affected joint were recorded. Activities of IL-1beta, IL-6, TNF-alpha, and MMP-3 and S-GAG contents were measured. Values were compared between groups by use of Mann-Whitney U tests, and the Spearman rank correlation test was used to evaluate correlations among markers and between each marker and clinical or radiographic variables. RESULTS Values of all markers were significantly higher for the clinical group, compared with values for the control group. There was a moderate positive correlation between lameness duration and IL-6 activity and a strong negative correlation between the Norberg angle and IL-1beta activity. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of our results indicated that there was a significant increase in markers of OA in dogs with HD. Activities of IL-1beta and IL-6 in joint fluid of dogs with HD may be influenced by the severity of laxity in the hip joint and lameness duration, respectively.
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Affiliation(s)
- Yukihiro Fujita
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Animal Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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Fujimura K, Segami N, Yoshitake Y, Tsuruoka N, Kaneyama K, Sato J, Kobayashi S. Electrophoretic separation of the synovial fluid proteins in patients with temporomandibular joint disorders. ACTA ACUST UNITED AC 2005; 101:463-8. [PMID: 16545710 DOI: 10.1016/j.tripleo.2005.02.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Revised: 02/23/2005] [Accepted: 02/25/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study was performed to characterize the patterns of protein expression in the synovial fluid (SF) of patients with temporomandibular joint disorders (TMD) by electrophoretic fractionation. STUDY DESIGN Samples of the SF of 26 consecutive patients consisting of 16 with closed locking (CL group) and 10 with osteoarthritis (OA group), as well as 7 asymptomatic control subjects (AS group), were analyzed in the present study. SF samples were obtained from the upper compartment of the temporomandibular joint (TMJ) and equal quantities of SF protein were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). RESULTS The mean total protein concentrations in the SF from both of the TMD groups were higher than that in the AS group (1353 microg/mL in the CL group and 2485 microg/mL in the OA group vs 615 microg/mL in the AS group; P < .01). Moreover, the mean total SF protein concentration was higher in the OA group than in the CL group (P < .01). There was a correlation between the total protein concentration in the SF from both patient groups and the degree of expanded joint effusion (P = .003, r = 0.685). Approximately 22 different protein bands with molecular weights ranging from 14 to 700 kd were clearly discernible on electrophoresis. The relative amounts of specific proteins in the SF of the TMD group were also different from those in the AS group (P < .05). The major difference in total protein concentration appeared to be due to the increased abundance of relatively high molecular weight proteins (>140 kd) in the TMD patients as compared to the AS group. CONCLUSIONS The SF of patients with TMD showed significant quantitative differences in total protein abundance as compared to healthy subjects. Moreover, this protein abundance was correlated strongly with the degree of expanded joint effusion. The major difference in total protein concentration appeared to be due to the increased abundance of relatively high molecular weight polypeptides in the TMD patients as compared to the healthy control subjects. These observations of changes in the pattern of protein expression may help in understanding the etiological factors involved in the pathophysiology of TMD.
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Affiliation(s)
- Kazuma Fujimura
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa Prefecture, 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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Güler N, Uçkan S, Imirzalioğlu P, Açikgözoğlu S. Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid. Dentomaxillofac Radiol 2005; 34:175-81. [PMID: 15897289 DOI: 10.1259/dmfr/49181266] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine whether there is any association between the protein concentration in the synovial fluid and (i) the amount of articular hydrops, as graded in magnetic resonance (MR) images, and (ii) joint pain in temporomandibular joints (TMJs) with and without displacement of the disc. PATIENTS AND METHODS This study involved 16 joints in 16 patients referred to our clinic with the complaint of pain and limited mouth opening. The control group consisted of 15 joints in 15 patients with unilaterally normal disc and condyle relationship and no pain while the opposite side had a non-painful joint with disc displacement without reduction (DDwoR). The subjects and controls were different individuals and only a single joint was used for each. Pain and dysfunction were evaluated by visual analogue scale. Bilateral proton density and T2 weighted images of the TMJs of the 31 subjects were analysed for fluid and condyle bony changes as well as disc position. The amount of fluid, identified as an area of high signal intensity in the region of the upper and lower joint spaces, was characterized as none, minimal, moderate or marked. Arthrocentesis was performed both for synovial fluid analysis of total protein concentration and the treatment of the joints with DDwoR. Total protein concentration was measured by using protein dye binding on spectrophotometry. RESULTS All patients experienced a significant (P<0.01) increase in maximal mouth opening immediately post-arthrocentesis. In the study group, the disc was displaced most frequently in an anteriormedial direction (75%) and deformation of disc form was seen in 13 joints. Condylar bony changes were seen in 27% of joints in the control group and in 81% of joints in the study group. A statistically significant association was found between joints with disc displacement, disc form and condylar bony changes (P<0.05). In the control group, only one joint, which had an osteophyte, showed joint effusion (JE) with moderate fluid. In the study group, only four joints had no fluid (25%). JE was found in 10 (63%) joints with disc displacement on anteromedial direction, in 10 (63%) joints with disc deformation and in 10 (63%) joints with osteophytes and erosion. Mean total protein concentration was 16.87+/-7.9 (range 7.4-34.1 mg dl-1) in control joints, 55.08+/-35.16 (range 21.5-153.9 mg dl-1) in study joints. There were significant differences in the mean total protein concentration between the control and study groups (P<0.01). Significant positive correlation was found between the total protein concentration and JE (r=0.65, P<0.01). No significant correlation was found between the level of pain and dysfunction and JE and total protein concentration in either control or study groups (P>0.05). CONCLUSION Pain in the TMJ was not related to MR findings of effusion in internal derangement and synovial fluid aspirate findings of total protein concentration. However, total protein concentration was related to the amount of JE in DDwoR joints and painful joints were more likely to demonstrate the JE.
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Affiliation(s)
- N Güler
- Yeditepe Universitesi, Dis Hekimligi Fakultesi, Bagdat cad. No: 238 Goztepe Istanbul, Turkiye.
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Kaneyama K, Segami N, Sun W, Sato J, Fujimura K. Levels of soluble cytokine factors in temporomandibular joint effusions seen on magnetic resonance images. ACTA ACUST UNITED AC 2005; 99:411-8. [PMID: 15772591 DOI: 10.1016/j.tripleo.2004.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To elucidate the correlations between joint effusion (JE) on T2-weighted magnetic resonance images (MRI) of the temporomandibular joint (TMJ) and the levels of various cytokine receptors, cytokine antagonists, and protein in the synovial fluid of patients with temporomandibular joint disorders (TMD). STUDY DESIGN Fifty-five TMJs of 55 patients with TMD were scanned by MRI, and synovial fluid samples were obtained on the same day. The grade of JE was evaluated on a scale of 0 to 3: Grades 0 and 1 indicated absence, and grades 2 and 3 indicated the presence of JE. Correlations were evaluated between JE and the concentrations of soluble tumor necrosis factor receptors I and II (sTNFR-I and sTNFR-II, respectively), IL-6 soluble receptor (IL-6sR), IL-1 soluble receptor type II, and IL-1 receptor antagonist and protein in the synovial fluid of patients with TMD. RESULTS The concentrations of sTNFR-I and protein in the group with JE (18 joints) were significantly higher than in the group without JE (37 joints). In addition, there were significant positive correlations between the grade of JE and the levels of sTNFR-I, sTNFR-II, and protein. CONCLUSIONS sTNFRs and protein may play important roles in the pathogenesis of TMD. These mediators seem to influence the expression of JE, which may reflect synovial inflammation of the TMJ.
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MESH Headings
- Adult
- Arthralgia/metabolism
- Arthralgia/therapy
- Case-Control Studies
- Etanercept
- Humans
- Immunoglobulin G/analysis
- Immunoglobulin G/metabolism
- Interleukin 1 Receptor Antagonist Protein
- Joint Dislocations/metabolism
- Joint Dislocations/pathology
- Magnetic Resonance Imaging
- Male
- Paracentesis
- Proteins/analysis
- Proteins/metabolism
- Range of Motion, Articular
- Receptors, Interleukin/analysis
- Receptors, Interleukin/antagonists & inhibitors
- Receptors, Interleukin/metabolism
- Receptors, Interleukin-1/analysis
- Receptors, Interleukin-1/antagonists & inhibitors
- Receptors, Interleukin-1/metabolism
- Receptors, Interleukin-6/analysis
- Receptors, Interleukin-6/metabolism
- Receptors, Tumor Necrosis Factor/analysis
- Receptors, Tumor Necrosis Factor/metabolism
- Sialoglycoproteins/analysis
- Sialoglycoproteins/metabolism
- Statistics, Nonparametric
- Synovial Fluid/chemistry
- Temporomandibular Joint Disorders/metabolism
- Temporomandibular Joint Disorders/pathology
- Temporomandibular Joint Disorders/therapy
- Treatment Outcome
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Affiliation(s)
- Keiseki Kaneyama
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Japan.
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Kaneyama K, Segami N, Sun W, Sato J, Fujimura K. Analysis of tumor necrosis factor-α, interleukin-6, interleukin-1β, soluble tumor necrosis factor receptors I and II, interleukin-6 soluble receptor, interleukin-1 soluble receptor type II, interleukin-1 receptor antagonist, and protein in the synovial fluid of patients with temporomandibular joint disorders. ACTA ACUST UNITED AC 2005; 99:276-84. [PMID: 15716832 DOI: 10.1016/j.tripleo.2004.06.074] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To measure the levels of various cytokines, cytokine receptors, and cytokine antagonists in the synovial fluid of patients with temporomandibular disorders (TMD) and to determine the correlations among these expression levels. STUDY DESIGN Synovial fluid was obtained from 55 patients with TMD and from 5 asymptomatic healthy volunteers as controls. The concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-1beta, soluble tumor necrosis factor receptors I and II (sTNFR-I and sTNFR-II), IL-6 soluble receptor (IL-6sR), IL-1 soluble receptor type II, and IL-1 receptor antagonist were determined by enzyme-linked immunosorbent assay. RESULTS The concentrations of TNF-alpha, IL-6, IL-1beta, sTNFR-I, and sTNFR-II were significantly higher in the synovial fluid of patients than in controls (P < .05). TNF-alpha level was positively correlated with those of IL-6, sTNFR-I, and sTNFR-II. In particular, there was a highly significant positive correlation between sTNFR-I and sTNFR-II. CONCLUSION TNF and sTNFRs in the synovial fluid of patients with TMD may be important in the pathogenesis of these disorders.
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Affiliation(s)
- Keiseki Kaneyama
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Ishikawa-Ken, Japan.
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Fujimura K, Kobayashi S, Suzuki T, Segami N. Histologic evaluation of temporomandibular arthritis induced by mild mechanical loading in rabbits. J Oral Pathol Med 2005; 34:157-63. [PMID: 15689229 DOI: 10.1111/j.1600-0714.2004.00298.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We still lack knowledge of causative factors in arthritis related to temporomandibular disorders (TMD). The goal of the present study was to investigate whether applying a mechanical loading on the glenoid fossa can induce arthritis. METHODS Coil springs were placed in 24 rabbits so as to exert a force of 100 g between the orbital edge and the antegonial notch. At 1, 2, 4 and 8 weeks after the surgery, six samples of the temporomandibular joint (TMJ) were removed for histologic examination. RESULTS The results showed that mild synovitis began 1-2 weeks after the start of loading, and the degree of synovitis was significant at 4 weeks, and that morphologic changes occurred in the articular eminence and condyle, while type II collagen in the cartilage of the articular eminence degraded prior to that in the condyle. CONCLUSIONS Our results revealed that mild, continuous mechanical loading to the glenoid fossa induces synovitis of the articular capsule, and induces organic changes of the articular cartilage without destroying these tissues.
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Affiliation(s)
- Kazuma Fujimura
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan.
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Sato J, Segami N, Kaneyama K, Mashiyama Y, Fujimura K, Yoshitake Y. Vascular endothelial growth factor concentrations in synovial fluids of patients with symptomatic internal derangement of the temporomandibular joint. J Oral Pathol Med 2005; 34:170-7. [PMID: 15689231 DOI: 10.1111/j.1600-0714.2004.00286.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) is an inducer of angiogenesis and permeability of small blood vessels. We determined the concentrations of VEGF in synovial fluid of patients with symptomatic internal derangement of the temporomandibular joint (TMJ). METHODS Diluted synovial fluid was collected by a pumping procedure from 22 TMJs of patients with internal derangement and 10 control TMJs. VEGF concentration was determined by an enzyme-linked immunosorbent assay. RESULTS The VEGF was detected in 14 of the 22 joints (64%) of patients with internal derangement, at a mean concentration of 67 pg/ml, but in only one control joint (12.5 pg/ml) (P = 0.004 for the difference in concentration). There was a significant correlation between VEGF concentration and total protein concentration in the synovial fluid (P = 0.002). CONCLUSIONS The increased concentration of VEGF in patients with symptomatic internal derangement suggests that this growth factor may be involved in the pathogenesis of this condition.
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Affiliation(s)
- Jun Sato
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan.
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Abstract
Articular cartilage is a specialized tissue uniquely suited for load distribution with a low-friction articulating surface. Its compressive and tensile properties are determined by its matrix and fluid composition, and are maintained by chondrocytes in the homeostatic joint. Osteoarthritis (OA) is increasingly understood as a family of disorders in which the biomechanical properties of cartilage are altered and ultimately fail as the tissue is degraded by local proteases. Mechanically mediated and cytokine-mediated pathways of cartilage degeneration have been identified in the pathogenesis of OA. Further insight into the basic science of cartilage and OA is necessary to develop diagnostic and treatment strategies for this pervasive disease.
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Affiliation(s)
- Andrew D Pearle
- Shoulder and Sports Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, USA.
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Mori S, Kaneda T, Lee K, Kato M, Motohashi J, Ogura I. T2-weighted MRI for the assessment of joint effusion: comparative study of conventional spin-echo and fast spin-echo sequences. ACTA ACUST UNITED AC 2004; 97:768-74. [PMID: 15184862 DOI: 10.1016/j.tripleo.2004.02.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the usefulness of suitable conventional spin-echo (CSE) and fast spin-echo (FSE) T2-weighted imaging parameters for the assessment of joint effusion in a phantom study and in a comparative study of CSE and FSE using clinical cases. STUDY DESIGN In the phantom study, the signal ratios of water and oil signal fields were determined and studied comparatively. The shape and size of signals were evaluated separately. In the study of joint effusion images, 318 joints were evaluated. CSE T2-weighted imaging and FSE T2-weighted imaging were carried out, and a comparative assessment was performed. RESULTS In both CSE and FSE imaging, the ratios of mean MRI signal values showed divergence as TR/TE values increased. The evaluation of joint effusion with FSE TR/TE 8000/120 msec was significantly better than that in all other groups (P <.01). CONCLUSION The use of FSE requires investigation of TR/TE values. When a 0.5 T static field strength MRI apparatus is employed, TR/TE 8000/120 msec is recommended.
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Affiliation(s)
- Shintaro Mori
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan.
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Uehara J, Kuboki T, Fujisawa T, Kojima S, Maekawa K, Yatani H. Soluble tumour necrosis factor receptors in synovial fluids from temporomandibular joints with painful anterior disc displacement without reduction and osteoarthritis. Arch Oral Biol 2004; 49:133-42. [PMID: 14693207 DOI: 10.1016/j.archoralbio.2003.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to detect soluble-form tumour necrosis factor receptors (sTNFRs) in temporomandibular joint (TMJ) synovial fluid aspirates, and to compare the sTNFR concentrations between painful anterior disc displacement without reduction and osteoarthritis (ADDwoR/OA) and asymptomatic TMJs. Synovial fluid was sampled from the superior TMJ cavity of 11 painful ADDwoR/OA cases (mean age: 36.9 years) and 10 asymptomatic females (mean age: 24.7 years) by diluted aspiration. The concentrations of sTNFR-I and -II in the synovial fluid were measured using human sTNFR-I and -II enzyme-linked immunosorbent assays. The total protein concentrations in synovial fluids were measured using a bicinchoninic acid protein assay kit. All data were normalised to the total protein concentration of each sample.Two-way factorial analysis of variance and post hoc multiple comparison revealed that: (1). mean normalised sTNFR-I and -II concentrations were higher in TMJ synovial aspirates from ADDwoR/OA patients than from healthy controls; (2). in the ADDwoR/OA patients and the healthy controls, the sTNFR-I concentration in TMJ synovial aspirates was higher than the sTNFR-II concentration; and (3). high TMJ synovial aspirate sTNFR-II seemed to be associated with less TMJ pain and a less restricted range of mouth opening in the ADDwoR/OA patients. The concentrations of sTNFRs in TMJ synovial fluid are higher in the presence of painful ADDwoR/OA, which could modulate intracapsular inflammation.
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Affiliation(s)
- Junji Uehara
- Department of Oral and Maxillofacial Rehabilitation, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8525, Japan
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Sato J, Segami N, Kaneyama K, Konishi H, Yoshitake Y, Nishikawa K. Levels of fibroblast growth factor 2 in synovial fluids in human patients with internal derangement of the temporomandibular joint. ACTA ACUST UNITED AC 2003; 96:673-9. [PMID: 14676757 DOI: 10.1016/j.tripleo.2003.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We sought to elucidate the levels of fibroblast growth factor 2 (FGF-2) in synovial fluid taken from internally deranged human temporomandibular joints (TMJs) and to discuss the role of FGF-2 in the pathogenesis of internal derangement. STUDY DESIGN Through the use of a pumping procedure, diluted synovial fluid was collected from the upper joint compartment of 22 TMJs with evidence of internal derangement (21 patients) and 8 TMJs with no such evidence (5 control subjects). Two of the control subjects were patients who had habitual dislocation, and three were healthy volunteers. The level of FGF-2 in the synovial fluid was assessed by means of an enzyme-linked immunosorbent assay. RESULTS FGF-2 levels were at detectable levels in 15 of the 22 TMJs (68%) with internal derangement. The mean concentration of FGF-2 was 24 pg/mL. In the control group, FGF-2 levels were detectable in only 1 of 8 joints (13%), for a concentration of 3 pg/mL. The mean concentration of FGF-2 in the synovial fluid was significantly higher in the internal derangement group than in the control group (P =.02). CONCLUSIONS FGF-2 levels are elevated in the human synovial fluid of TMJs with internal derangement.
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Affiliation(s)
- Jun Sato
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Uchinada, Ishikawa Prefecture, Japan.
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Ishimaru JI, Ogi N, Mizui T, Miyamoto K, Shibata T, Kurita K. Effects of a single arthrocentesis and a COX-2 inhibitor on disorders of temporomandibular joints. Br J Oral Maxillofac Surg 2003; 41:323-8. [PMID: 14581025 DOI: 10.1016/s0266-4356(03)00134-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Our aim was to examine the short-term effect of combined treatment with single arthrocentesis and a COX-2 inhibitor on 26 patients with severe symptoms of temporomandibular joint (TMJ) disorders. The severity of the disorders was graded according to the degree of restriction of mouth opening and pain score on a visual analogue scale. Synovial fluid was collected from the superior joint space of the affected TMJ, and arthrocentesis was done with isotonic saline, 200ml. Subsequently, etodolac, 400mg/day, was given for 2 weeks. At 14 days, patients were re-examined and further specimens of synovial fluid were collected. Patients generally lost their symptoms and the severity of the disorders improved significantly (P<0.01). The concentrations of total protein and albumin in synovial fluid decreased with no statistical significance. However, the concentration of matrix metalloproteinase-3 and its ratios to total protein and albumin did decrease significantly (P<0.05). Our results suggest that a larger controlled study is necessary to clarify the contributory effect of arthrocentesis and etodolac for patients with severe symptoms of TMJ disorders.
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Affiliation(s)
- J-I Ishimaru
- Department of Oral and Maxillofacial Surgery, Gifu Prefectural Gifu Hospital, Gifu, Japan.
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