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Shivakumar S, Abdul NS, Jyoti B, Kalburgi V, Cicciù M, Minervini G. Comparative evaluation of cognitive behavioural therapy versus standard treatment in temporomandibular disorders: A systematic review. J Oral Rehabil 2024. [PMID: 39041325 DOI: 10.1111/joor.13792] [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: 07/10/2023] [Revised: 10/19/2023] [Accepted: 06/20/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are musculoskeletal and neuromuscular conditions affecting the temporomandibular joint and associated structures. Cognitive-behavioural therapy (CBT) has emerged as a potential intervention for TMDs, but its comparative effectiveness against standard treatments remains unclear. This systematic review aimed to evaluate and compare the efficacy of CBT versus standard treatment interventions in managing TMDs. METHODS A comprehensive search was conducted across multiple databases using MeSH keywords and Boolean operators. Inclusion criteria encompassed clinical trials comparing CBT/CBT in combination with standard treatment interventions or a control group in individuals with TMDs. The primary outcome measured was pain. Secondary outcomes such as disability, depression and jaw function were also looked into. Two reviewers independently assessed for the eligibility of the articles and conducted data extraction. Quality assessments were performed using RoB 2.0 for randomised clinical trials. RESULTS The initial search identified 623 articles, of which a total of eight clinical studies met the inclusion criteria and were included in the systematic review. Seven out of eight studies demonstrated improvements in outcomes related to TMD. Pain was significantly decreased in studies that showed a positive outcome. Jaw function, quality of life and psychological well-being were superior among individuals receiving CBT alone or in combination with conventional modalities, as well as hypnotic therapy coupled with CBT-based interventions. The quality of studies assessed showed all articles to be of good quality as per RoB-2 evaluation. CONCLUSION This systematic review highlights the potential benefits of CBT in managing TMDs, suggesting its effectiveness in improving pain outcomes and enhancing overall well-being. The findings indicate that CBT may be a valuable adjunct or alternative to standard treatment interventions for individuals with TMDs. However, further research with larger sample sizes and standardised outcome measures is warranted to establish definitive conclusions regarding the comparative efficacy of CBT versus standard treatments in TMD management.
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Affiliation(s)
- Sahana Shivakumar
- Public Health Dentistry, Peoples College of Dental Sciences and Research Centre Peoples University Bhopal, Bhopal, India
| | - Nishath Sayed Abdul
- Faculty of Oral Pathology, Department of OMFS and Diagnostic Sciences, Riyadh Elm University Riyadh, Riyadh, Saudi Arabia
| | - Bhuvan Jyoti
- Dental Surgeon and Consultant, Oral Medicine and Radiology Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Ranchi, India
| | - Veena Kalburgi
- Periodontics, Peoples College of Dental Sciences and Research Centre Peoples University Bhopal, Bhopal, India
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Wang Y, Gao W, Liang C, Jia F, Geng W. Influence on the temporomandibular joint induced by mandibular malpositioning caused by vertical dimension elevation and occlusal loss in adult rats: An imaging, histological and immunohistochemical study. J Oral Rehabil 2024. [PMID: 38783585 DOI: 10.1111/joor.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Mandibular malpositioning may result in an abnormal concentration of stresses within the temporomandibular joint (TMJ) in adult rats, which may further lead to a series of pathological changes, such as articular cartilage wear, subchondral bone sclerosis and osteophyte formation. However, the pathological and adaptive changes in condylar cartilage caused by different stress distributions are still controversial. OBJECTIVE The aim of this study was to observe the effect of sagittal changes in mandibular position on condylar cartilage by changing the occlusal vertical dimension (OVD) in adult rats. METHODS Fifteen-week-old female rats were divided into three groups: control (CON), increased OVD (iOVD) and loss of occlusion (LO) groups. An occlusal plate and tooth extraction were used to establish the animal model. TMJ samples of the experimental and CON groups were observed and investigated by bone morphological, histomorphological and immunohistochemical staining analyses at 3 days, 1 week, 2 weeks, 4 weeks and 8 weeks. Weight curves were plotted. RESULTS Micro-computed tomography showed that, compared with the CON group, cartilage destruction followed by repair occurred in both experimental groups, which was similar to the trend observed in haematoxylin-eosin staining. All experimental results for the iOVD group showed an approximately similar time trend. Compared with the iOVD group, the toluidine blue and immunohistochemical staining results in the LO group showed no obvious change trend over time. CONCLUSION Compared with occlusal loss, an increase in OVD caused faster and more severe damage to condylar cartilage, and subchondral bone repair occurred later.
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Affiliation(s)
- Yue Wang
- Department of Dental Implant Centre, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Wenmo Gao
- Department of Dental Implant Centre, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Chao Liang
- Department of Dental Implant Centre, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Fangwen Jia
- Department of Dental Implant Centre, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Wei Geng
- Department of Dental Implant Centre, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
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Yang C, Teng H, Shao B, Liu Z. Biomechanical study of temporomandibular joints of patients with temporomandibular disorders under incisal clenching: A finite element analysis. J Biomech 2024; 166:112065. [PMID: 38555778 DOI: 10.1016/j.jbiomech.2024.112065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
Temporomandibular disorders (TMD) encompass a collection of pathologies. Within the multitude of etiological factors contributing to TMD, mechanical factors hold significant importance. The aim of this investigation was to assess the magnitude and distribution of stresses encountered by the temporomandibular joints (TMJs) during incisal clenching among TMD patients while also elucidating the mechanical pathogenesis underlying TMD. Ten asymptomatic subjects and ten TMD patients were recruited. The Control, Bilateral, and Unilateral groups were set. The contact stress, maximum principal stress, and minimum principal stresses of TMJ structures among the groups were compared. In addition, comparisons of the contact stress distribution among the groups were adopted. In the Control and Bilateral groups, the magnitudes of stresses (contact stress, maximum and minimum principal stresses) between the right and left sides showed no significant difference (P > 0.05). For unilateral TMD patients,the minimum principal stress on the condyle in the Uni-N group (the normal side) was significantly greater than thatin the Uni-T group (the TMD side)(P = 0.016, mean difference 9.99 MPa [95 %CI: 3.11 to 16.87]). Furthermore, stresses on the condyle and fossa of the patients were significantly greater than those of asymptomatic subjects (P < 0.05). The contact stress distributions were concentrated in the Control group while irregular in the TMD groups. In conclusion, asymmetrical contact stress distributions were observed in unilateral TMD, with excessive stresses on the healthy side. The protection of the healthy TMJ during treatment is recommended for patients with unilateral TMD.
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Affiliation(s)
- Chunxin Yang
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu 610065, China; Yibin Institute of Industrial Technology/Sichuan University, Yibin Park, Yibin 644600, China
| | - Haidong Teng
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu 610065, China; Yibin Institute of Industrial Technology/Sichuan University, Yibin Park, Yibin 644600, China
| | - Bingmei Shao
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu 610065, China; Yibin Institute of Industrial Technology/Sichuan University, Yibin Park, Yibin 644600, China
| | - Zhan Liu
- Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu 610065, China; Yibin Institute of Industrial Technology/Sichuan University, Yibin Park, Yibin 644600, China.
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Kulesa-Mrowiecka M, Ciężarek P, Pihut M. Effectiveness of Rehabilitation for Disk Displacement of the Temporomandibular Joint-A Cross-Sectional Study. J Clin Med 2024; 13:902. [PMID: 38337596 PMCID: PMC10856411 DOI: 10.3390/jcm13030902] [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: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Dislocations of articular disk can occur as a result of parafunctions in the Temporo Mandibular Joint (TMJ), which limits the opening of the mandible and other movements. The aim of this study was to evaluate the effectiveness of rehabilitation in patients with disk displacement of the TMJ. A total of 327 subjects with Temporo Mandibular Disorders underwent stomathognatic physiotherapy. (2) Methods: Based on the results obtained by a manual functional analysis, 35 patients who were identified with articular disk locking (disk displacement without reduction) were included in the study. The study group (N = 35) was subjected to passive repositioning of the articular disk, reposition splints, and physiotherapy. The patient's TMJs were then examined before the therapy, immediately after the therapy, and during the follow-up visit 3-6 weeks after the therapy. The Diagnostic Criteria for the Most Common Intra-articular Temporomandibular Disorders was used to evaluate the effects of rehabilitation on the patients' range of motions and the Numeric Pain Rating Scale (NPRS). For the statistical analysis, Pearson's r correlation coefficient test and Wilcoxon signed-rank test were used. (3) Results: The results showed a significant improvement in the range of motion of the mandible movements. The level of improvement was dependent on the time from the incident until undergoing rehabilitation. (4) Conclusions: The stomatognathic physiotherapy applied increased the range of motion of the mandible and reduced pain levels to the expected range.
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Affiliation(s)
- Małgorzata Kulesa-Mrowiecka
- Department of Rehabilitation in Internal Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland
| | - Patryk Ciężarek
- Faculty of Health Science, Institute of Physiotherapy, Jagiellonian University Medical College, 31-126 Krakow, Poland;
| | - Małgorzata Pihut
- Prosthodontic Department, Faculty of Medicine, Institute of Dentistry, Jagiellonian University Medical College, 31-126 Krakow, Poland;
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Alam MK, Zaman MU, Alqhtani NR, Alqahtani AS, Alqahtani F, Cicciù M, Minervini G. Salivary Biomarkers and Temporomandibular Disorders: A Systematic Review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. J Oral Rehabil 2024; 51:416-426. [PMID: 37731276 DOI: 10.1111/joor.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The present review aimed to investigate the association between salivary biomarkers and temporomandibular disorders (TMD). TMD is a multifactorial condition characterised by pain and dysfunction in the temporomandibular joint (TMJ) and surrounding structures. Salivary biomarkers have emerged as potential diagnostic tools due to their non-invasiveness and easy accessibility. However, the literature on salivary biomarkers in relation to TMD is limited and inconsistent. METHODS Electronic databases of Pubmed, Embase, Web of Science, Scopus, Cochrane Library, PsychINFO, CINAHL and Medline were searched using specific search terms and Boolean operators. The search was limited to articles published in English that assessed salivary biomarkers in individuals diagnosed with TMD. Two reviewers independently screened the articles and extracted data. ROB-2 was used to assess the risk of bias. RESULTS Eleven clinical papers met the inclusion criteria and were included in the review. The findings provided consistent evidence of a clear association between salivary biomarkers and TMD. Various biomarkers, including cortisol, IL-1, glutamate and several others, were assessed. Some studies reported higher levels of cortisol and IL-1 in TMD patients, indicating potential involvement in stress and inflammation. Glutamate levels were found to be elevated, suggesting a role in pain modulation. Other biomarkers also showed alterations in TMD patients compared to controls: CONCLUSION: The findings from the included studies suggest that salivary biomarkers may play a role in TMD pathophysiology. Though a definitive conclusion can be drawn regarding the specific salivary biomarkers and their association with TMD, the results must be interpreted with caution considering the heterogeneity of the biomarkers assessed. Further research with larger sample sizes, standardised methodology and rigorous study designs is needed to elucidate the role of salivary biomarkers in TMD.
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Affiliation(s)
- Mohammad Khursheed Alam
- Preventive Dentistry Department, College of Dentistry, Jouf University, Skaka, Saudi Arabia
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Mahmud Uz Zaman
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdullaziz University, Al-kharj, Saudi Arabia
| | - Nasser Raqe Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdullaziz University, Al-kharj, Saudi Arabia
| | - Abdullah Saad Alqahtani
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdullaziz University, Al-kharj, Saudi Arabia
| | - Fawaz Alqahtani
- Department of Prosthodontics, School of Dentistry, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Teng H, Shu J, Ma H, Shao B, Liu Z. Effect of pre-stress on dynamic finite element analysis of the temporomandibular joint. Comput Methods Biomech Biomed Engin 2023:1-11. [PMID: 38083841 DOI: 10.1080/10255842.2023.2290455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/28/2023] [Indexed: 02/24/2024]
Abstract
The pre-stress of the temporomandibular joint (TMJ) at the intercuspal position (ICP) was often neglected, which would cause errors in the finite element analysis. The purpose of this study was to investigate the effect of pre-stress on dynamic finite element analysis of the TMJs. One healthy female adult was recruited for medical imaging and motion data acquisition of the reference position (RP) to the ICP and the clicking teeth. The three-dimensional maxillofacial model including the maxilla, mandible, articular cartilages, discs, and discal attachments was reconstructed. Motion from the RP to the ICP was simulated to obtain pre-stress at the ICP. Two groups of the clicking teeth were simulated: (1) the group without pre-stress (GWoP); (2) the group with pre-stress (GwP). Significant differences were found between the two groups at the initial moment of movement, during the open-mouth phase, and during the collision phase between the upper and lower teeth. The maximum difference in the discal contact stress between both groups was even more than double. The relaxation of the TMJ at the beginning of the mouth opening was simulated in the GwP. In addition, an increase in the TMJ stress during teeth tapping was simulated in the GwP. These were not reflected in the GWoP. If pre-stress at the ICP was not considered, part of the true results would be lost. It is necessary to consider pre-stress in the dynamic finite element analysis of the TMJ.
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Affiliation(s)
- Haidong Teng
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Jingheng Shu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Hedi Ma
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Bingmei Shao
- Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
- Basic Mechanics Lab, Sichuan University, Chengdu, China
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
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Gao W, Lu J, Gao X, Zhou J, Dai H, Sun M, Xu J. Biomechanical effects of joint disc perforation on the temporomandibular joint: a 3D finite element study. BMC Oral Health 2023; 23:943. [PMID: 38031042 PMCID: PMC10685656 DOI: 10.1186/s12903-023-03521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Disc perforation (DP) is a severe type of Temporomandibular Disorder (TMD). DP may induce changes in the internal stresses of the temporomandibular joint (TMJ). Herein, this study attempts to investigate the biomechanical effects of different positions and sizes of DP on the TMJ using a biomechanical approach, to explore the mechanical pathogenesis of TMD. METHODS Eleven three-dimensional finite element (FE)models of the TMJ were constructed based on CBCT imaging files of a patient with DP on the left side. These models included the disc with anterior displacement and discs with different locations and sizes of perforations on the affected disc. FE methods were conducted on these models. RESULTS Anterior displacement of the disc leads to a significant increase in the maxim von Mises stress (MVMS) in both TMJs, with the affected side exhibiting a more pronounced effect. DP occurring at the posterior band and the junction between the disc and the bilaminar region has a greater impact on the MVMS of both TMJs compared to perforations at other locations. As the size of the perforation increases, both sides of the TMJs exhibit an increase in the magnitude of MVMS. CONCLUSIONS Unilateral disc anterior displacement results in an increased stress on both TMJs. Unilateral DP further affects the stress on both sides of the TMJs. TMD is a progressive condition, and timely intervention is necessary in the early stages to prevent the worsening of the condition.
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Affiliation(s)
- Wentong Gao
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Lu
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xiang Gao
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jianping Zhou
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Hongwei Dai
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Min Sun
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Knee Joint Sports Injury, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan Province, China.
| | - Jie Xu
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China.
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China.
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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Huang D, Liu L, Zhai X, Wang Y, Hu Y, Xu X, Li H, Jiang H. Association between chewing side preference and MRI characteristics in patients with anterior disc displacement of the temporomandibular joint. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101484. [PMID: 37094731 DOI: 10.1016/j.jormas.2023.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To compare the magnetic resonance imaging (MRI) characteristics in the anterior disc displacement (ADD) patients with and without chewing side preference (CSP). METHODS The MRI characteristics of the bilateral temporomandibular joint (TMJ) in 111 patients with ADD were retrospectively analysed. Based on the presence of CSP, all subjects were divided into the non-CSP group (NC group, N = 40) and CSP group (C group, N = 71). Based on the preferred chewing side in the C group, the patients were divided into ipsilateral and contralateral sides. The morphology, length, disc-condyle angle, and coordinate position of the disc and condyle of the bilateral TMJ were compared. RESULTS MRI examination showed a significant difference between ipsilateral and contralateral joint displacement in patients with CSP (P<0.05). In CSP patients, the disc length of the same side in the ipsilateral side was significantly shorter than the contralateral side (P<0.05). A significant difference in the Y-axis coordinates of the ipsilateral and contralateral discs was also found in patients with CSP (P<0.05). The disc displacement grade, morphology of the articular disc, ipsilateral disc length, and ipsilateral disc-condyle Y-axis distance were positively correlated with CSP (P<0.05). CONCLUSION CSP is related to the shape of the articular disc and disc-condyle position in patients with ADD. CSP may aggravate the development of ADD.
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Affiliation(s)
- Dongzong Huang
- Medical School of Chinese PLA, Beijing 100853, China; Department of Stomatology, the first Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
| | - Lin Liu
- Department of Stomatology, the first Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
| | - Xiaoting Zhai
- Medical School of Chinese PLA, Beijing 100853, China; Department of Stomatology, the first Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yan Wang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yifan Hu
- Medical School of Chinese PLA, Beijing 100853, China; Department of Stomatology, the first Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
| | - Xinyu Xu
- Medical School of Chinese PLA, Beijing 100853, China; Department of Stomatology, the first Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
| | - Hongbo Li
- Department of Stomatology, the first Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
| | - Hua Jiang
- Department of Stomatology, the first Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.
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Minervini G, Franco R, Marrapodi MM, Fiorillo L, Cervino G, Cicciù M. Post-traumatic stress, prevalence of temporomandibular disorders in war veterans: Systematic review with meta-analysis. J Oral Rehabil 2023; 50:1101-1109. [PMID: 37300526 DOI: 10.1111/joor.13535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/04/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The physical and psychological effects of war are not always easy to detect, but they can be far-reaching and long-lasting. One of the physical effects that may result from war stress is temporomandibular disorder (TMD). OBJECTIVE To evaluate the prevalence of TMD sign and symptoms among war veterans diagnosed with PTSD. METHODS We systematically searched in Web of Science, PubMed and Lilacs for articles published from the inception until 30 December 2022. All documents were assessed for eligibility based on the following Population, Exposure, Comparator and Outcomes (PECO) model: (P) Participants consisted of human subjects. (E) The Exposure consisted of exposition to war. (C) The Comparison was between war veterans (subjects exposed to war) and subjects not exposed to war. (O) The Outcome consisted of presence of temporomandibular disorders sign or symptoms (we considered pain to muscle palpation in war veterans). RESULTS Forty studies were identified at the end of the research. We chose only four study to draw up the present systematic study. The included subjects were 596. Among them, 274 were exposed to war, whereas the remaining 322 were not exposed to war stress. Among those exposed to war, 154 presented sign/symptoms of TMD (56.2%) whereas only 65 of those not exposed to war (20.18%). The overall effect revealed that subjects exposed to war and diagnosed with PTSD had a higher prevalence of TMD signs (pain at muscle palpation) than controls (RR 2.21; 95% CI: 1.13-4.34), showing an association PTSD war-related and TMD. CONCLUSIONS War can cause lasting physical and psychological damage that can lead to chronic diseases. Our results clearly demonstrated that war exposure, directly or indirectly, increases the risk of developing TMJ dysfunction and TMD sign/symptoms.
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Affiliation(s)
- Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Franco
- Department of Biomedicine and Prevention, University of University of Rome "Tor Vergata", Rome, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - Luca Fiorillo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Prosthodontics, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
- School of Dentistry Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Gabriele Cervino
- School of Dentistry Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
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Seyedpour SM, Nafisi S, Nabati M, Pierce DM, Reichenbach JR, Ricken T. Magnetic Resonance Imaging-based biomechanical simulation of cartilage: A systematic review. J Mech Behav Biomed Mater 2021; 126:104963. [PMID: 34894500 DOI: 10.1016/j.jmbbm.2021.104963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/30/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022]
Abstract
MRI-based mathematical and computational modeling studies can contribute to a better understanding of the mechanisms governing cartilage's mechanical performance and cartilage disease. In addition, distinct modeling of cartilage is needed to optimize artificial cartilage production. These studies have opened up the prospect of further deepening our understanding of cartilage function. Furthermore, these studies reveal the initiation of an engineering-level approach to how cartilage disease affects material properties and cartilage function. Aimed at researchers in the field of MRI-based cartilage simulation, research articles pertinent to MRI-based cartilage modeling were identified, reviewed, and summarized systematically. Various MRI applications for cartilage modeling are highlighted, and the limitations of different constitutive models used are addressed. In addition, the clinical application of simulations and studied diseases are discussed. The paper's quality, based on the developed questionnaire, was assessed, and out of 79 reviewed papers, 34 papers were determined as high-quality. Due to the lack of the best constitutive models for various clinical conditions, researchers may consider the effect of constitutive material models on the cartilage disease simulation. In the future, research groups may incorporate various aspects of machine learning into constitutive models and MRI data extraction to further refine the study methodology. Moreover, researchers should strive for further reproducibility and rigorous model validation and verification, such as gait analysis.
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Affiliation(s)
- S M Seyedpour
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany; Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany
| | - S Nafisi
- Faculty of Pharmacy, Istinye University, Maltepe, Cirpici Yolu B Ck. No. 9, 34010 Zeytinburnu, Istanbul, Turkey
| | - M Nabati
- Department of Mechanical Engineering, Faculty of Engineering, Boğaziçi University, 34342 Bebek, Istanbul, Turkey
| | - D M Pierce
- Department of Mechanical Engineering, University of Connecticut, 191 Auditorium Road, Unit 3139, Storrs, CT, 06269, USA; Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Unit 3247, Storrs, CT, 06269, USA
| | - J R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany; Center of Medical Optics and Photonics, Friedrich Schiller University Jena, Germany; Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Germany
| | - T Ricken
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany; Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany.
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He J, Ran J, Zheng B, Algahefi A, Liu Y. Finite element analysis of various thickness occlusal stabilization splint therapy on unilateral temporomandibular joint anterior disc displacement without reduction. Am J Orthod Dentofacial Orthop 2021; 161:e277-e286. [PMID: 34776321 DOI: 10.1016/j.ajodo.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Occlusal stabilization splint is the most common treatment modality for temporomandibular joint disorders, but the optimal thickness is still uncertain. This study investigated the effect of the occlusal splint with different thicknesses on the stress distribution of the temporomandibular joint. METHODS Cone-beam computed tomography and magnetic resonance images were used to reconstruct the maxillofacial and disc, and the unilateral anterior disc displacement without reduction was established manually as the basic model. Occlusal splint with 5 different thickness levels (2, 3, 4, 5, and 6 mm) was added to the basic model as the study models. The displacement and stress distribution of the disc were evaluated. RESULTS The maximum von Mises stress of the condylar cartilage was the largest on the affected side, whereas the maximum von Mises stress of the disc was the largest on the unaffected side. The disc stress on the affected side was mainly distributed on the posterior zone and the intermediate zone for the unaffected side. The maximum von Mises stress of the bilaminar region on the affected side was greater than the unaffected side. The stress of the disc and bilaminar region was the lowest on the affected side in the 2 mm model. The disc displacement on the affected side gradually increased, whereas, on the unaffected side, it fluctuated. CONCLUSIONS These results showed that occlusal stabilization splint could decrease the stress of disc and bilaminar region, and 2 mm was considered the optimal thickness for the treatment of unilateral temporomandibular joint anterior disc displacement without reduction.
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Affiliation(s)
- Jia He
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Junyi Ran
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Bowen Zheng
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Ahmed Algahefi
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Yi Liu
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China.
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12
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Poluha RL, Canales GDLT, Bonjardim LR, Conti PCR. Oral behaviors, bruxism, malocclusion and painful temporomandibular joint clicking: is there an association? Braz Oral Res 2021; 35:e090. [PMID: 34378672 DOI: 10.1590/1807-3107bor-2021.vol35.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Abstract
The present cross-sectional case-control study aimed to determine if there is an association between specific oral behaviors, sleep bruxism (SB), awake bruxism (AB), and painful temporomandibular joint (TMJ) clicking. Ninety individuals were dived into three groups; Group 1 (n = 30): painful TMJ clicking; Group 2 (n = 30): painless TMJ clicking; and Group 3 (n = 30): control group. The following clinical data were studied: oral behaviors (unilateral chewing, gum chewing, nail biting, foreign objects biting, leaning with jaw against the hand, and sleeping in a position that pressures the jaw), SB, AB (including the frequency in 10 days, evaluated by ecological momentary assessment), and malocclusions investigated based on clinical inspections (anterior open bite, posterior cross-bite, abnormal overbite/overjet, occlusal guidance, mediotrusive and/or laterotrusive interferences, retruded contact position to maximum intercuspation slide, missing posterior teeth). All statistical tests (Kolmogorov-Smirnov, chi-square, and one-way ANOVA) were performed with a 5% significance level. Group 1 had the highest frequency of and a significant association with leaning with jaw in the hand, sleeping position that pressures the jaw, gum chewing, nail biting, and AB (p<0.05). Gum chewing, nail biting, and AB were associated with Group 2 only when compared to Group 3 (p<0.05). No significant difference among groups was found for other behaviors (unilateral chewing and foreign objects biting), SB, and all malocclusions (p>0.05). It can be concluded that patients with painful TMJ clicking had a higher frequency of and a significant association with some specific harmful behaviors and AB.
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Affiliation(s)
- Rodrigo Lorenzi Poluha
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Prosthodontics, Bauru, SP, Brazil
| | | | - Leonardo Rigoldi Bonjardim
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Biological Sciences, Bauru, SP, Brazil
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Ortún-Terrazas J, Cegoñino J, Pérez Del Palomar A. Biomechanical impact of the porous-fibrous tissue behaviour in the temporomandibular joint movements. An in silico approach. J Mech Behav Biomed Mater 2021; 120:104542. [PMID: 33962235 DOI: 10.1016/j.jmbbm.2021.104542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
The movement of the temporomandibular joint (TMJ) is a function of its complex geometry and its interaction with the surrounding soft tissues. Owing to an increase in the prevalence of temporomandibular joint disorders (TMDs), many computational studies have attempted to characterize its biomechanical behaviour in the last 2 decades. However, most such studies are based on a single computational model that markedly simplifies the complex geometry and mechanical properties of the TMJ's soft tissues. The present study aims to computationally evaluate in a wider sample the importance of considering their complex anatomy and behaviour for simulating both damping and motion responses of this joint. Hence, 6 finite element models of healthy volunteers' TMJ were developed and subjected to both conditions in two different behavioural scenarios. In one, the soft tissues' behaviour was modelled by considering the porous-fibrous properties, whereas in the other case they were simplified assuming isotropic-hyperelastic response, as had been traditionally considered. The damping analysis, which mimic the conditions of an experimental test of the literature, consisted of applying two different compressive loads to the jaw. The motion analysis evaluated the condylar path during the mandible centric depression by the action of muscular forces. From the results of both analyses, the contact pressures, intra-articular fluid pressure, path features, and stress/strain values were compared using the porous-fibrous and isotropic-hyperelastic models. Besides the great differences observed between patients due patient-specific morphology, the porous-fibrous approach yielded results closer to the reference experimental values and to the outcomes of other computational studies of the literature. Our findings underscore, therefore, the importance of considering realistic joint geometries and porous-fibrous contribution in the computational modelling of the TMJ, but also in the design of further joint replacements or in the development of new biomaterials for this joint.
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Affiliation(s)
- Javier Ortún-Terrazas
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.
| | - José Cegoñino
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Amaya Pérez Del Palomar
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
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García N, Fernández P, Tanaka E, Barrientos E, Lamela-Rey MJ, Fernández-Canteli A, de Vicente JC. Effect of region-dependent viscoelastic properties on the TMJ articular disc relaxation under prolonged clenching. J Mech Behav Biomed Mater 2021; 119:104522. [PMID: 33895662 DOI: 10.1016/j.jmbbm.2021.104522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023]
Abstract
The disc of the temporomandibular joint (TMJ) is located between the mandibular condyle and temporal bone, and has an important load-bearing and stress absorbing function. The TMJ disc presents viscoelastic characteristics that are largely dependent on its collagen fibre and proteoglycan composition and organization. The purpose of this study is to investigate the possible effects of region-specific dynamic viscoelastic properties on stress relaxation during prolonged clenching. Two finite element models were used to compare the stress distribution within the TMJ disc, namely, one with uniform disc material property and another one with region-specific disc material properties. Similar results were observed in both models with slight differences in the location of maximum stress. Larger stresses were observed in all cases for the model with uniform disc material property. Moreover, the higher values for the model with uniform disc material property appeared in the lateral region, while in the model with region-specific disc properties, these values moved to the lateral and central region. This investigation confirms that both models are sufficiently accurate to investigate stress distribution in the TMJ disc, and, particularly, the model with the region-specific disc material properties ensure better simulations of the TMJ disc behaviour.
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Affiliation(s)
- Natalia García
- Department of Construction and Manufacturing Engineering, University of Oviedo, Gijón, Spain
| | - Pelayo Fernández
- Department of Construction and Manufacturing Engineering, University of Oviedo, Gijón, Spain.
| | - Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Eva Barrientos
- Department of Construction and Manufacturing Engineering, University of Oviedo, Gijón, Spain
| | - María Jesús Lamela-Rey
- Department of Construction and Manufacturing Engineering, University of Oviedo, Gijón, Spain
| | | | - Juan Carlos de Vicente
- Department of Surgery and Medical Surgical Specialities, University of Oviedo, Oviedo, Spain
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Silva CAGD, Grossi ML, Araldi JC, Corso LL. Can hard and/or soft occlusal splints reduce the bite force transmitted to the teeth and temporomandibular joint discs? A finite element method analysis. Cranio 2020:1-8. [PMID: 33280545 DOI: 10.1080/08869634.2020.1853464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To test whether two different materials used for occlusal splints would reduce the stress to the temporomandibular joint discs.Methods: Geometric data from a young-adult male patient were obtained from computed tomography and magnetic resonance imaging. 3D biomodels and the finite element analyses were performed using specific software.Results: The mandibular model presented the highest bone stress areas in the mandibular rami and insertion of the temporalis muscles. Regardless the material, the highest stress in the occlusal splints was located in the second molar regions on the occlusal splint surface and in the opposing mandibular second molars. Stress reduction was only observed in the internal surface of the occlusal splints embracing the maxillary teeth. No differences between occlusal splints were found in the stress intensity and distribution in either left or right TMJ discs, being concentrated more in the anterior portion of the disc.Discussion: Hard acrylic OS should be preferred over soft EVA OS in the majority of cases, soft OS only for temporary use. Thinner OS (2-3 mm anterior thickness) should be preferred over thick ones (3-4 mm) in order to keep the stress concentrations in the center of the TMJ discs. Lighter contacts over heavier contacts should be preferred in the second molar OS contact surface area to prevent stress concentrations and fractures. Maxillary occlusal splints should be chosen if the teeth or implant are in the maxilla, and vice-versa.
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Affiliation(s)
- Carlos Augusto Gomes Da Silva
- School of Health Sciences, Postgraduate Program in Dentistry (Prosthodontics), Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Márcio Lima Grossi
- School of Health Sciences, Postgraduate Program in Dentistry (Prosthodontics), Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Jonatas Comparin Araldi
- Postgraduate Program in Engineering, Faculty of Engineering, Caxias Do Sul University, Caxias Do Sul, Brazil
| | - Leandro Luis Corso
- Postgraduate Program in Engineering, Faculty of Engineering, Caxias Do Sul University, Caxias Do Sul, Brazil
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Barrientos E, Pelayo F, Tanaka E, Lamela-Rey MJ, Fernández-Canteli A, de Vicente JC. Effects of loading direction in prolonged clenching on stress distribution in the temporomandibular joint. J Mech Behav Biomed Mater 2020; 112:104029. [DOI: 10.1016/j.jmbbm.2020.104029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
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Poluha RL, De la Torre Canales G, Bonjardim LR, Conti PCR. Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking. Clin Oral Investig 2020; 25:3633-3640. [PMID: 33184719 DOI: 10.1007/s00784-020-03685-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study and estimate the impact of clinical, somatosensory, and psychosocial variables associated with the concomitant presence of temporomandibular joint (TMJ) pain in patients with TMJ clicking. MATERIALS AND METHODS Ninety-three individuals composed the sample: patients with painful TMJ clicking (n = 47) and patients with painless TMJ clicking (n = 46). Four categories of data were evaluated: clinical features (gender, maximal interincisal distance (MID), side of complaint, age); bruxism (sleep bruxism (SB), awake bruxism (AB)); somatosensory (mechanical pain threshold (MPT), wind-up ratio (WUR), pressure pain threshold (PPT), conditioned pain modulation (CPM)); and psychosocial (Pittsburgh Sleep Quality Index (PSQI), pain vigilance and awareness questionnaire (PVAQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK/TMD), Oral Behaviors (OBs)). RESULTS Female gender, AB, WUR, CPM, PSQI, PCS, and OBs significantly (p < 0.05) increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. On the other hand, MID, MPT, and PPT significantly (p < 0.05) decreased this chance. The other variables had no association. CONCLUSION It can be concluded that being a woman, having AB, hyperalgesia in WUR, less efficient CPM, poor sleep quality, pain catastrophizing, and harmful OBs significantly increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. In the opposite, high figures of MID, MPT, and PPT decreased the chance. CLINICAL RELEVANCE Most patients with TMJ clicking usually postpone seeking treatment until the clicking truly disturbs or there is a concomitant presence of TMJ pain. Understanding the variables associated with this concomitance can be important in clinical practice.
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Affiliation(s)
- Rodrigo Lorenzi Poluha
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, 17012-901, Brazil.
| | - Giancarlo De la Torre Canales
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, 17012-901, Brazil
| | - Leonardo Rigoldi Bonjardim
- Bauru Orofacial Pain Group, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, 17012-901, Brazil
| | - Paulo César Rodrigues Conti
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, 17012-901, Brazil
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Paluch Ł, Maj P, Pietruski P, Korba M, Noszczyk BH. Shear Wave Elastography in the Evaluation of Temporomandibular Joint Disorders. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:46-54. [PMID: 31635758 DOI: 10.1016/j.ultrasmedbio.2019.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
We aimed at verifying the usefulness of shear wave elastography in determining the temporomandibular disc stiffness in patients with a temporomandibular disorders (TMDs). The study included 37 patients with confirmed TMDs and 208 healthy volunteers. Patients presented with significantly greater stiffness of the intermediate zone of the disc (region of interest [ROI] 1) and significantly lower stiffness of its anteriorly displaced portion (ROI 3). A receiver operating characteristics analysis indicated that a decrease in the stiffness in ROI 3 less than 8.667 KPa provided 100% sensitivity, 97.3% specificity, 100% positive predictive value (PPV) and 99.5% negative predictive value (NPV) in distinguishing between patients with TMDs and without. Whereas an increase in ROI 1 stiffness to at least 54.33 KPa provided high specificity and NPV, both the sensitivity and the PPV of this predictor equaled zero. Findings suggest that a decrease in anteriorly dislocated disc stiffness less than 8.667 kPa can accurately identify patients with TMDs.
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Affiliation(s)
- Łukasz Paluch
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
| | - Paulina Maj
- Department of Head and Neck Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Pietruski
- Department of Plastic Surgery, Orłowski Hospital, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Korba
- Department of Cranio-Maxillofacial Surgery, Oral Surgery and Implantology, Medical University of Warsaw, Poland
| | - Bartłomiej H Noszczyk
- Department of Plastic Surgery, Orłowski Hospital, Center of Postgraduate Medical Education, Warsaw, Poland.
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Cui SJ, Fu Y, Liu Y, Kou XX, Zhang JN, Gan YH, Zhou YH, Wang XD. Chronic inflammation deteriorates structure and function of collagen fibril in rat temporomandibular joint disc. Int J Oral Sci 2019; 11:2. [PMID: 30783108 PMCID: PMC6381164 DOI: 10.1038/s41368-018-0036-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 11/09/2022] Open
Abstract
Collagen is the building component of temporomandibular joint (TMJ) discs and is often affected by inflammation in temporomandibular disorders. The macromechanical properties of collagen are deteriorated by chronic inflammation. However, the mechanism by which inflammation influences disc function remains unknown. The relationship between the ultrastructure and nanomechanical properties of collagen in inflamed discs should be clarified. Seven-week-old female Sprague-Dawley rats were randomly divided into two groups. Chronic TMJ inflammation was induced by intra-articular injection of complete Freund's adjuvant, and samples were harvested after 5 weeks. Picrosirius staining revealed multiple colours under polarized light, which represented alternative collagen bundles in inflamed discs. Using atomic force microscopy scanning, the magnitude of Young's modulus was reduced significantly accompanied with disordered collagen fibril arrangement with porous architecture of inflamed discs. Transmission electron microscopy scanning revealed a non-uniform distribution of collagen fibres, and oversized collagen fibrils were observed in inflamed discs. Fourier transform infrared microspectroscopy revealed a decrease in 1 338 cm-1/amide II area ratio of collagen in different regions. The peak positions of amide I and amide II bands were altered in inflamed discs, indicating collagen unfolding. Our results suggest that sustained inflammation deteriorates collagen structures, resulting in the deterioration of the ultrastructure and nanomechanical properties of rat TMJ discs.
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Affiliation(s)
- Sheng-Jie Cui
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China.,Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China
| | - Yu Fu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China.,Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China
| | - Yan Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China.,Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China
| | - Xiao-Xing Kou
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China.,Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China
| | - Jie-Ni Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China.,Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China
| | - Ye-Hua Gan
- Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China
| | - Yan-Heng Zhou
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China. .,Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China.
| | - Xue-Dong Wang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China. .,Center for Craniofacial Stem Cell Research and Regeneration, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District, Beijing, China.
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Jiménez-Silva A, Peña-Durán C, Tobar-Reyes J, Frugone-Zambra R. Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: A systematic review from 2003 to 2014. Acta Odontol Scand 2017; 75:36-58. [PMID: 27796166 DOI: 10.1080/00016357.2016.1247465] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE In order to establish a relationship between bruxism and temporomandibular disorders (TMDs), a systematic review was performed. MATERIALS AND METHODS A systematic research was performed based on PubMed, Cochrane Library, Medline, Embase, BIREME, Lilacs and Scielo data bases, between 2003 and 2014 including all languages. Descriptive clinical cases were identified. Two independent authors selected the articles. PICO format was used to analyse the studies and the Newcastle-Ottawa Scale (NOS) was used to verify the quality of the evidence. RESULTS Thirty-nine studies (n = 39) were analysed in this review. According to bruxism diagnosis, articles were grouped as follows: polysomnographic diagnosis (PSG) (n = 7), clinical diagnosis (n = 11) and survey/self-report (n = 21). Thirty-three articles (n = 33) established a positive relation between bruxism and TMD and six (n = 6) did not. Quality of evidence was low to moderate. In general, the most part of the studies showed shortcomings on their design with bias risk, and also had a low sensitivity on bruxism diagnosis. CONCLUSIONS The evidence based on PSG was not as conclusive as the studies that used surveys and clinical exam to diagnosis bruxism, when bruxism was related to TMD. Sleep bruxism could be associated with myofascial pain, arthralgia and joint pathology as disc displacement and joint noises. Although the evidence at present is inconclusive and does not provide information according to the type of bruxism (bruxism sleep and wakefulness), it is possible to suggest that bruxism would be associated with TMD.
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Disk displacement, eccentric condylar position, osteoarthrosis - misnomers for variations of normality? Results and interpretations from an MRI study in two age cohorts. BMC Oral Health 2016; 16:124. [PMID: 27855674 PMCID: PMC5114831 DOI: 10.1186/s12903-016-0319-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/09/2016] [Indexed: 01/25/2023] Open
Abstract
Background Clinical decision-making and prognostic statements in individuals with manifest or suspected temporomandibular disorders (TMDs) may involve assessment of (a) the position of articular disc relative to the mandibular condyle, (b) the location of the condyle relative to the temporal joint surfaces, and (c) the depth of the glenoid fossa of the temporomandibular joints (TMJs). The aim of this study was twofold: (1) Determination of the prevalence of these variables in two representative population-based birth cohorts. (2) Reinterpretation of the clinical significance of the findings. Methods From existing magnetic resonance imaging (MRI) scans of the TMJs that had been taken in 2005 and 2006 from 72 subjects born between 1930 and 1932 and between 1950 and 1952, respectively, the condylar position at closed jaw was calculated as percentage displacement of the condyle from absolute centricity. By using the criteria introduced by Orsini et al. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:489-97, 1998), a textbook-like disc position at closed jaw was distinguished from an anterior location. TMJ morphology of the temporal joint surfaces was assessed at open jaw by measuring the depth of the glenoid fossa, using the method proposed by Muto et al. (J Oral Maxillofac Surg 52:1269-72, 1994). Frequency distributions were recorded for the condylar and disc positions at closed jaw. Student’s t-test with independent samples was used as test of significance to detect differences of condylar positions between the age cohorts (1930 vs. 1950) and the sexes. The significance levels were set at 5%. First, the results from the measurement of the age cohorts were compared without differentiation of sexes, i.e., age cohort 1930–1932 versus age cohort 1950–1952. Subsequently, the age cohorts were compared by sex, i.e., men in cohort 1930–1932 versus men in cohort 1950–1952, and women in cohort 1930–1932 women men in cohort 1950–1952. Results In both cohorts, condylar position was characterized by great variability. About 50% of the condyles were located centrically, while the other half was either in an anterior or in a posterior position. In both female cohorts, a posterior position predominated, whereas a centric position prevailed among men. Around 75% of the discs were positioned textbook-like, while the remaining forth was located anteriorly. Age had no statistically significant influence on condylar or on disc position. Conversely, comparison between the age groups revealed a statistically significant decrease of the depth of the glenoid fossa in both older cohorts. This age-dependent changes may be interpreted as flattening of the temporal joint surfaces. Conclusions We call for a re-interpretation of imaging findings because they may insinuate pathology which usually is not present. Instead, anterior or posterior positions of the mandibular condyle as well as an anterior location of the articular disc should be construed as a variation of normalcy. Likewise, flattening of articular surfaces of the TMJs may be considered as normal adaptive responses to increased loading, rather than pathological degenerative changes. Trial registration Not applicable.
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Ma D, Kou X, Jin J, Xu T, Wu M, Deng L, Fu L, Liu Y, Wu G, Lu H. Hydrostatic Compress Force Enhances the Viability and Decreases the Apoptosis of Condylar Chondrocytes through Integrin-FAK-ERK/PI3K Pathway. Int J Mol Sci 2016; 17:ijms17111847. [PMID: 27827993 PMCID: PMC5133847 DOI: 10.3390/ijms17111847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/27/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023] Open
Abstract
Reduced mechanical stimuli in many pathological cases, such as hemimastication and limited masticatory movements, can significantly affect the metabolic activity of mandibular condylar chondrocytes and the growth of mandibles. However, the molecular mechanisms for these phenomena remain unclear. In this study, we hypothesized that integrin-focal adhesion kinase (FAK)-ERK (extracellular signal-regulated kinase)/PI3K (phosphatidylinositol-3-kinase) signaling pathway mediated the cellular response of condylar chondrocytes to mechanical loading. Primary condylar chondrocytes were exposed to hydrostatic compressive forces (HCFs) of different magnitudes (0, 50, 100, 150, 200, and 250 kPa) for 2 h. We measured the viability, morphology, and apoptosis of the chondrocytes with different treatments as well as the gene, protein expression, and phosphorylation of mechanosensitivity-related molecules, such as integrin α2, integrin α5, integrin β1, FAK, ERK, and PI3K. HCFs could significantly increase the viability and surface area of condylar chondrocytes and decrease their apoptosis in a dose-dependent manner. HCF of 250 kPa resulted in a 1.51 ± 0.02-fold increase of cell viability and reduced the ratio of apoptotic cells from 18.10% ± 0.56% to 7.30% ± 1.43%. HCFs could significantly enhance the mRNA and protein expression of integrin α2, integrin α5, and integrin β1 in a dose-dependent manner, but not ERK1, ERK2, or PI3K. Instead, HCF could significantly increase phosphorylation levels of FAK, ERK1/2, and PI3K in a dose-dependent manner. Cilengitide, the potent integrin inhibitor, could dose-dependently block such effects of HCFs. HCFs enhances the viability and decreases the apoptosis of condylar chondrocytes through the integrin-FAK-ERK/PI3K pathway.
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Affiliation(s)
- Dandan Ma
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, China.
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), VU University Amsterdam and University of Amsterdam, MOVE Research Institute, Gustav Mahlerlaan 3004, Amsterdam 1081LA, Nord-Holland, The Netherlands.
| | - Xiaoxing Kou
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing 100081, China.
| | - Jing Jin
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Taotao Xu
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China.
| | - Mengjie Wu
- Department of Orthodontics, Stomatology Hospital Affiliated to Zhejiang University, Hangzhou 310053, China.
| | - Liquan Deng
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Lusi Fu
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Yi Liu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), VU University Amsterdam and University of Amsterdam, MOVE Research Institute, Gustav Mahlerlaan 3004, Amsterdam 1081LA, Nord-Holland, The Netherlands.
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), VU University Amsterdam and University of Amsterdam, MOVE Research Institute, Gustav Mahlerlaan 3004, Amsterdam 1081LA, Nord-Holland, The Netherlands.
| | - Haiping Lu
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, China.
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El-Zawahry MM, El-Ragi AA, El-Anwar MI, Ibraheem EM. The Biomechanical Effect of Different Denture Base Materials on the Articular Disc in Complete Denture Wearers: A Finite Element Analysis. Open Access Maced J Med Sci 2015; 3:455-61. [PMID: 27275270 PMCID: PMC4877839 DOI: 10.3889/oamjms.2015.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/07/2015] [Accepted: 06/09/2015] [Indexed: 12/02/2022] Open
Abstract
AIM: The objective of the present study was to evaluate the effect of different denture base materials on the stress distribution in TMJ articular disc (AD) in complete denture wearers. MATERIAL AND METHODS: A three dimensional Finite Element (FEA) models of an individual temporomandibular joint (TMJ) was built on the basis CT scan. The FEA model consisted of four parts: the condyle, the articular disc, the denture base, and the articular eminence skull. Acrylic resin and chrome-cobalt denture base materials were studied. Static loading of 300N was vertically applied to the central fossa of the mandibular second premolar. Stress and strain were calculated to characterize the stress/strain patterns in the disc. RESULTS: The maximum tensile stresses were observed in the anterior and posterior bands of (AD) on load application with the two denture base materials. The superior boundaries of the glenoid fossa showed lower stress than those on the inferior boundaries facing the condyle. CONCLUSIONS: Within the limitations of the present study it may be concluded that: The denture base material may have an effect in stress-strain pattern in TMJ articular disc. The stiffer denture base material, the better the distribution of the load to the underling mandibular supporting structures & reducing stresses induced in the articular disc.
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Affiliation(s)
| | - Ahmed A El-Ragi
- Civil Engineering Department, Faculty of Engineering, Fayoum University, Egypt
| | | | - Eman M Ibraheem
- Prosthodontics Department, National Research Centre, Giza, Egypt
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Hattori-Hara E, Mitsui SN, Mori H, Arafurue K, Kawaoka T, Ueda K, Yasue A, Kuroda S, Koolstra JH, Tanaka E. The influence of unilateral disc displacement on stress in the contralateral joint with a normally positioned disc in a human temporomandibular joint: An analytic approach using the finite element method. J Craniomaxillofac Surg 2014; 42:2018-24. [DOI: 10.1016/j.jcms.2014.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/11/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022] Open
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Li Q, Ren S, Ge C, Sun H, Lu H, Duan Y, Rong Q. Effect of jaw opening on the stress pattern in a normal human articular disc: finite element analysis based on MRI images. Head Face Med 2014; 10:24. [PMID: 24943463 PMCID: PMC4082420 DOI: 10.1186/1746-160x-10-24] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/13/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Excessive compressive and shear stresses are likely related to condylar resorption and disc perforation. Few studies have reported the disc displacement and deformation during jaw opening. The aim of this study was to analyze stress distribution in a normal articular disc during the jaw opening movement. METHODS Bilateral MRI images were obtained from the temporomandibular joint of a healthy subject for the jaw opening displacement from 6 to 24 mm with 1 mm increments. The disc contour for the jaw opening at 6 mm was defined as the reference state, and was used to establish a two dimensional finite element model of the disc. The contours of the disc at other degrees of jaw opening were used as the displacement loading. Hyperelastic material models were applied to the anterior, intermediate and posterior parts of the disc. Stress and strain trajectories were calculated to characterize the stress/strain patterns in the disc. RESULTS Both the maximum and minimum principal stresses were negative in the intermediate zone, therefore, the intermediate zone withstood mainly compressive stress. On the contrary, the maximum and minimum principal stresses were most positive in the anterior and posterior zones, which meant that the anterior and posterior bands suffered higher tensile stresses. The different patterns of stress trajectories between the intermediate zone and the anterior and posterior bands might be attributed to the effect of fiber orientation. The compression of the intermediate zone and stretching of the anterior and posterior bands caused high shear deformation in the transition region, especially at the disc surfaces. CONCLUSIONS The stress and strain remained at a reasonable level during jaw opening, indicating that the disc experiences no injury during functional opening movements in a healthy temporomandibular joint.
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Affiliation(s)
| | | | | | | | | | | | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China.
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