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Murakami K, Yamamoto K, Kawakami M, Horita S, Kirita T. Changes in strain energy density in the temporomandibular joint disk after sagittal split ramus osteotomy using a computed tomography-based finite element model. J Orofac Orthop 2024; 85:289-305. [PMID: 36629885 DOI: 10.1007/s00056-022-00441-3] [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: 02/04/2022] [Accepted: 11/13/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE We evaluated the changes in the strain energy density (SED) in the temporomandibular joint (TMJ) disk after sagittal split ramus osteotomy (SSRO) at three time points. A finite element model (FEM) based on real patient-based computed tomography (CT) data was used to examine the effect of SSRO on the TMJ. METHODS Measurements of the condylar position and angulation in CT images and FEM analyses were performed for 17 patients scheduled to undergo SSROs at the following time points: before surgery, immediately after surgery, and 1 year after surgery. SED on the entire disk was calculated at each of the three time points using FEM. Furthermore, the relationship between individual SED values and the corresponding condylar position was also evaluated. RESULTS No significant change was observed in the condylar position at the three time points. The FEM analysis showed that SED was the highest and lowest immediately after and 1 year after surgery, respectively. A possible SED distribution imbalance between the left and right joints was improved 1 year after SSRO. Concerning the effect of fossa morphometry and condylar position, wide and deep glenoid fossae and a more posterior condylar position tended to show lower SED. CONCLUSION SED in the articular disk temporarily increased after surgery and significantly decreased 1 year after surgery compared with that before surgery. SSRO generally improved the imbalance between the left and right joints. Thus, SSRO, which improves maxillofacial morphology, may also improve components of temporomandibular disorders.
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Affiliation(s)
- Kazuhiro Murakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan.
| | - Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - Masayoshi Kawakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - Satoshi Horita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara, Nara 634-8522, Japan
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Koca CG, Yildirim B, Bilgir E. Effects of bruxism on temporomandibular joint internal derangement in patients with unilateral temporomandibular joint pain: The role of magnetic resonance imaging diagnostics. Cranio 2024; 42:113-121. [PMID: 33896412 DOI: 10.1080/08869634.2021.1918959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study compared temporomandibular joint (TMJ) magnetic resonance imaging (MRI) findings between bruxism and control groups with unilateral TMJ pain as well as the TMJ MRI findings for the painful and non-painful sides of individuals in the two groups. METHODS Clinical and MRI findings of patients seen at Uşak University, Dentistry Faculty, Department of Oral and Maxillofacial Surgery for unilateral TMJ pain between 2017 and 2020 were analyzed. Bruxism was diagnosed based on clinical findings and patient history. The MRI variables were disc/condyle relationship (normal, disc displacement with reduction, or disc displacement without reduction), disc structure (normal and abnormal), condyle degeneration type (normal, moderate, or severe), and joint effusion (absent or present). Pain was recorded based on a visual analog scale (VAS) numbered between 0 and 10. Statistical analyses were performed using IBM SPSS. The data were distributed non-normally according to the results of Kolmogorov-Smirnov tests. The Mann-Whitney U test was used to compare age and VAS. Chi-square tests were used to compare categorical variables. Statistical significance was defined as p < 0.05. RESULTS This study assessed the MRI records of 558 cases of TMJ pain. No significant differences in disc/condyle relation, disc structure, condyle structure, or effusion were observed between the control and bruxism groups (p > 0.05). However, a significant difference in TMJ MRI findings was observed between the painful and non-painful sides of each individual in the control and bruxism groups (p = 0.001, p < 0.001 and p = 0.004, p < 0.001, respectively). CONCLUSION The results of this study established a relationship between the painful side for each patient and TMJ MRI findings. In particular, individuals with bruxism had a higher rate of TMJ internal derangement and effusion on the painful side.
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Affiliation(s)
- Cansu Gül Koca
- Uşak University, Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Uşak, Turkey
| | - Bengisu Yildirim
- Uşak University, Dentistry Faculty, Department of Prosthodontics, Uşak, Turkey
| | - Elif Bilgir
- Osmangazi University, Dentistry Faculty, Department of Oral and Maxillofacial Radiology, Eskişehir, Turkey
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Martenot A, Devoti JF, Pons M, Meyer C, Brumpt E, Louvrier A, Bertin E. Persistent myogenic temporomandibular disorders: Are navigation-guided botulinum toxin-A injections into the lateral pterygoid muscles effective? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 125:101715. [PMID: 38013116 DOI: 10.1016/j.jormas.2023.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Botulinum toxin has proven effective in treating persistent myogenous temporomandibular disorders (M-TMDs) unresponsive to conservative therapies. While the usual injection sites are the masseter and temporalis muscles, the deeper lateral pterygoid muscle (LPM) is often overlooked due to its difficulty of access and the risk of local complications. This study aims to evaluate the effectiveness of botulinum toxin-A injections (BTX-A) in the LPM with MR-guided navigation of patients with persistent M-TMDs. METHODS This retrospective study enrolled 34 patients suffering from M-TMDs despite conservative therapies with a total of 51 injection sessions. All of them were treated by BTX-A injections in the LPM using MR-guided navigation, masseter and temporalis with clinical guidance. The effectiveness of the treatment was evaluated with measures of maximum pain-intensity scores of breakthrough and background pain, maximal interincisal mouth opening (MIO), and the presence of joint sounds. The assessment was conducted before injections, and subsequently, at 1 and 3 months postoperatively. Adverse events and perception of improvement with the treatment were also reported for each injection sessions. RESULTS BTX-A injections in the LPM significantly improved pain scores intensity with a reduction of 65 % and 49 % respectively at the 1- and 3-month follow-ups, with peak effectiveness at 1 month. This study showed also a statistically significant improvement in mean MIO at 3 months post-injection and a decrease in joint sounds with persistence in 9,7 % of cases at 3-month follow-up compared to 41,2 % at baseline. No significant adverse events were observed. Patients treated with BTX-A injections in the LPM had a subjective complete improvement in their perception of treatment efficacy in 63 % of cases at the end of the follow-up period. CONCLUSIONS This study reports clinical experience on the use of MR-guided navigation to perform accurate, reliable, and safe BTX-A injections in the LPM. Although our results appear to be encouraging regarding symptom improvement of patients suffering from persistent M-TMDs, this approach may not be feasible as a primary standard procedure for managing M-TMDs. Further research is necessary to explore potential reproducible, safe, and cost-effective alternatives to enhance the accessibility of the LPM in clinical practice.
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Affiliation(s)
- Alexis Martenot
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France.
| | - Jean-François Devoti
- Université de Lorraine, CHU Nancy, Service de Chirurgie Maxillo-Faciale, Plastique, Reconstructrice et Esthétique, Nancy F-54000, France
| | - Mélanie Pons
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France
| | - Christophe Meyer
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France; Université de Franche-Comté, LNIT, Besançon F-25000, France; Université de Franche-Comté, CHU Besançon, Plateforme I3DM (Impression 3D Médicale), Besançon F-25000, France
| | - Eléonore Brumpt
- Université de Franche-Comté, LNIT, Besançon F-25000, France; Université de Franche-Comté, CHU Besançon, Radiologie, Besançon F-25000, France
| | - Aurélien Louvrier
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France; Université de Franche-Comté, LNIT, Besançon F-25000, France; Université de Franche-Comté, CHU Besançon, Plateforme I3DM (Impression 3D Médicale), Besançon F-25000, France
| | - Eugénie Bertin
- Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France
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4
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Zhang Y, Keilig L, Dörsam I, Bourauel C. Numerical investigation of the biomechanical effects of orthodontic intermaxillary elastics on the temporomandibular joint. J Mech Behav Biomed Mater 2023; 141:105764. [PMID: 36965216 DOI: 10.1016/j.jmbbm.2023.105764] [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: 12/20/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
Temporomandibular joint disorder (TMD) often coincides with malocclusion, and in some cases TMDs are reported after orthodontic treatment. Intermaxillary elastics (also known as orthodontic elastics, OE) are a common way to apply force during orthodontic treatment, and they might cause mechanical effects on the temporomandibular joint (TMJ), thereby lead to joint remodeling. It is still a controversial topic whether the adapted remodeling of the TMJ or of the alveolar bone is the main cause for the alteration of occlusion after treatment with OEs. It was the aim of this study to analyze whether variations of OEs would develop harmful effects on the healthy TMJ. A TMJ model with a masticatory system based on Hill-type muscle actuators was established. Mouth opening and closure with and without OEs were simulated, and maximum principal stresses in the disc and condylar cartilage as well as the displacement of the mandible were analyzed. We found no considerably difference in the mandibular movement without and with symmetrical OEs during mouth opening and closing. At full mouth opening, stresses in the disc and condylar cartilage of some models with OEs were much smaller than without OEs, but we did not find consistency in the results from the left and right sides of the same model (e.g. the lowest compressive stress on the left side of disc from the model with Class II OEs is much smaller than without OEs, -17.3 MPa compared with -28.2, while on the right side, there was no obvious difference). Hence, we could not conclude that OEs would develop deleterious effects on the healthy TMJ.
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Affiliation(s)
- Yaqiu Zhang
- Oral Technology, Dental School, University Hospital Bonn, Bonn, Germany.
| | - Ludger Keilig
- Oral Technology, Dental School, University Hospital Bonn, Bonn, Germany; Department of Dental Prosthetics, Propaedeutics and Materials Science, Dental School, University Hospital Bonn, Bonn, Germany
| | - Istabrak Dörsam
- Department of Dental Prosthetics, Propaedeutics and Materials Science, Dental School, University Hospital Bonn, Bonn, Germany
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Effat KG. Temporomandibular disorder: A previously unreported complication of chronic suppurative otitis media. Cranio 2022:1-6. [PMID: 36538022 DOI: 10.1080/08869634.2022.2157525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of the current clinical study was to test the hypothesis that chronic suppurative otitis media (CSOM) might be significantly associated with signs of temporomandibular joint (TMJ) internal derangement. METHODS The study involved 79 patients with CSOM and 79 control subjects. The TMJ was clinically examined in both groups. RESULTS Signs of internal derangement of the TMJ(s) were found in 67.1% of CSOM patients versus 26.6% of control subjects (p = .001). CONCLUSION CSOM may be associated with the extension of the inflammatory process into the TMJ, thereby predisposing to internal derangement of the joint.
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Affiliation(s)
- Kamal G Effat
- Department of Otolaryngology, El- Sahel Teaching Hospital, Cairo, Egypt
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6
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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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Tribst JPM, Dal Piva AMDO, Bottino MA, Kleverlaan CJ, Koolstra JH. Mouthguard use and TMJ injury prevention with different occlusions: A three‐dimensional finite element analysis. Dent Traumatol 2020; 36:662-669. [DOI: 10.1111/edt.12577] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Affiliation(s)
- João Paulo Mendes Tribst
- Department of Dental Materials and Prosthodontics São Paulo State University (Unesp/SJC) São Paulo Brazil
- Department of Dental Materials Science Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
| | - Amanda Maria de Oliveira Dal Piva
- Department of Dental Materials and Prosthodontics São Paulo State University (Unesp/SJC) São Paulo Brazil
- Department of Dental Materials Science Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
| | - Marco Antonio Bottino
- Department of Dental Materials and Prosthodontics São Paulo State University (Unesp/SJC) São Paulo Brazil
| | - Cornelis Johannes Kleverlaan
- Department of Dental Materials Science Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
| | - Jan Harm Koolstra
- Department of Oral Cell Biology and Functional Anatomy Academic Center for Dentistry Amsterdam (ACTA) University of Amsterdam and VU University Amsterdam Amsterdam The Netherlands
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8
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Lai L, Huang C, Zhou F, Xia F, Xiong G. Finite elements analysis of the temporomandibular joint disc in patients with intra-articular disorders. BMC Oral Health 2020; 20:93. [PMID: 32228551 PMCID: PMC7106847 DOI: 10.1186/s12903-020-01074-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background Intra-articular disorders (ID) or anterior and/or medial displacement of the temporomandibular joint disorder (TMJ) disc are the most common form of TMJ dysfunction (TMD). TMD causes changes in the friction coefficient during TMJ movement. Herein, we provided a three-dimensional (3D) finite-elements model (FEM) including the maxilla, disc, and mandible and evaluated the stress distribution with different friction coefficient. Methods Fourteen volunteers without TMD and 20 patients with MRI-diagnosed TMD were selected. CT and MRI data were collected to build the 3D FEA model of the mandible and TMJ disc. Stress distribution with different friction coefficient was measured. Result In the normal model, stress distribution on the TMJ disc was 2.07 ± 0.17, 1.49 ± 0.14, and 1.41 ± 0.14 MPa with 0.001, 0.3, and 0.4 friction coefficient, respectively. In the TMD model, stress distribution was 3.87 ± 0.15, 7.23 ± 0.22, and 7.77 ± 0.19 MPa respectively. Conclusion When the friction coefficient of the side with anterior displacement increased, stress on the disc, condyle and mandible of the opposite side increased. Simultaneously, stress values of the disc, condyle and mandible were higher than those of the normal lateral joint.
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Affiliation(s)
- Linfeng Lai
- Department of Oral Surgery, The Dingling Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chenyao Huang
- Department of Oral Surgery, The Dingling Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Fan Zhou
- Department of Oral Surgery, The Dingling Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Fujian Xia
- Department of Oral Surgery, The Dingling Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Guofeng Xiong
- Department of Oral Surgery, The Dingling Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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9
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Extraoral Versus Intraoral Botulinum Toxin Type A Injection for Management of Temporomandibular Joint Disc Displacement With Reduction. J Craniofac Surg 2019; 30:2149-2153. [DOI: 10.1097/scs.0000000000005658] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Barrientos E, Pelayo F, Tanaka E, Lamela-Rey MJ, Fernández-Canteli A. Viscoelastic properties of the central region of porcine temporomandibular joint disc in shear stress-relaxation. J Biomech 2019; 93:126-131. [PMID: 31301763 DOI: 10.1016/j.jbiomech.2019.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/14/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022]
Abstract
In this study, shear relaxation properties of the porcine temporomandibular joint (TMJ) disc are investigated. Previous studies have shown that, in fatigue failure and damage of cartilage and fibrocartilage, shear loads could be one of the biggest contributors to the failure. The aim of the present study is to develop an evaluation method to study shear properties of the disc and to do a mathematical characterization of it. For the experiments, twelve porcine discs were used. Each disc was dissected from the TMJ and, then, static strain control tests were carried out to obtain the shear relaxation modulus for the central region of the discs. From the results, it was found that the disc presents a viscoelastic behavior under shear loads. Relaxation modulus decreased with time. Shear relaxation was 10% of the instantaneous stress, which implies that the viscous properties of the disc cannot be neglected. The present results lead to a better understanding of the discs mechanical behavior under realistic TMJ working conditions.
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Affiliation(s)
- Eva Barrientos
- Department of Construction and Manufacturing Engineering, University of Oviedo, Gijón, Spain.
| | - Fernandez Pelayo
- 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
| | - María Jesús Lamela-Rey
- Department of Construction and Manufacturing Engineering, University of Oviedo, Gijón, Spain
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11
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Wu Y, Cisewski SE, Coombs MC, Brown MH, Wei F, She X, Kern MJ, Gonzalez YM, Gallo LM, Colombo V, Iwasaki LR, Nickel JC, Yao H. Effect of Sustained Joint Loading on TMJ Disc Nutrient Environment. J Dent Res 2019; 98:888-895. [PMID: 31126205 DOI: 10.1177/0022034519851044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The temporomandibular joint (TMJ) disc nutrient environment profoundly affects cell energy metabolism, proliferation, and biosynthesis. Due to technical challenges of in vivo measurements, the human TMJ disc extracellular nutrient environment under load, which depends on metabolic rates, solute diffusion, and disc morphometry, remains unknown. Therefore, the study objective was to predict the TMJ disc nutrient environment under loading conditions using combined experimental and computational modeling approaches. Specifically, glucose consumption and lactate production rates of porcine TMJ discs were measured under varying tissue culture conditions (n = 40 discs), and mechanical strain-dependent glucose and lactate diffusivities were measured using a custom diffusion chamber (n = 6 discs). TMJ anatomy and loading area were obtained from magnetic resonance imaging of healthy human volunteers (n = 11, male, 30 ± 9 y). Using experimentally determined nutrient metabolic rates, solute diffusivities, TMJ anatomy, and loading areas, subject-specific finite element (FE) models were developed to predict the 3-dimensional nutrient profiles in unloaded and loaded TMJ discs (unloaded, 0% strain, 20% strain). From the FE models, glucose, lactate, and oxygen concentration ranges for unloaded healthy human TMJ discs were 0.6 to 4.0 mM, 0.9 to 5.0 mM, and 0% to 6%, respectively, with steep gradients in the anterior and posterior bands. Sustained mechanical loading significantly reduced nutrient levels (P < 0.001), with a critical zone in which cells may die representing approximately 13.5% of the total disc volume. In conclusion, this study experimentally determined TMJ disc metabolic rates, solute diffusivities, and disc morphometry, and through subject-specific FE modeling, revealed critical interactions between mechanical loading and nutrient supply and metabolism for the in vivo human TMJ disc. The results suggest that TMJ disc homeostasis may be vulnerable to pathological loading (e.g., clenching, bruxism), which impedes nutrient supply. Given difficulties associated with direct in vivo measurements, this study provides a new approach to systematically investigate homeostatic and degenerative mechanisms associated with the TMJ disc.
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Affiliation(s)
- Y Wu
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,2 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - S E Cisewski
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - M C Coombs
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - M H Brown
- 3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - F Wei
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - X She
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - M J Kern
- 3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
| | - Y M Gonzalez
- 4 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - L M Gallo
- 5 Clinic of Masticatory Disorders, University of Zurich, School of Dental Medicine, Zurich, Switzerland
| | - V Colombo
- 5 Clinic of Masticatory Disorders, University of Zurich, School of Dental Medicine, Zurich, Switzerland
| | - L R Iwasaki
- 6 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - J C Nickel
- 6 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - H Yao
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA.,2 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA.,3 Department of Oral Health Sciences, College of Dental Medicine, MUSC, Charleston, SC, USA
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12
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Wu Y, Cisewski SE, Wei F, She X, Gonzales TS, Iwasaki LR, Nickel JC, Yao H. Fluid pressurization and tractional forces during TMJ disc loading: A biphasic finite element analysis. Orthod Craniofac Res 2017; 20 Suppl 1:151-156. [PMID: 28643926 PMCID: PMC5928793 DOI: 10.1111/ocr.12147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the ploughing mechanism associated with tractional force formation on the temporomandibular joint (TMJ) disc surface. SETTING AND SAMPLE POPULATION Ten left TMJ discs were harvested from 6- to 8-month-old male Yorkshire pigs. MATERIALS AND METHODS Confined compression tests characterized mechanical TMJ disc properties, which were incorporated into a biphasic finite element model (FEM). The FEM was established to investigate load carriage within the extracellular matrix (ECM) and the ploughing mechanism during tractional force formation by simulating previous in vitro plough experiments. RESULTS Biphasic mechanical properties were determined in five TMJ disc regions (average±standard deviation for aggregate modulus: 0.077±0.040 MPa; hydraulic permeability: 0.88±0.37×10-3 mm4 /Ns). FE simulation results demonstrated that interstitial fluid pressurization is a dominant loading support mechanism in the TMJ disc. Increased contact load and duration led to increased solid ECM strain and stress within, and increased ploughing force on the surface of the disc. CONCLUSION Sustained mechanical loading may play a role in load carriage within the ECM and ploughing force formation during stress-field translation at the condyle-disc interface. This study further elucidated the mechanism of ploughing on tractional force formation and provided a baseline for future analysis of TMJ mechanics, cartilage fatigue and early TMJ degeneration.
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Affiliation(s)
- Y. Wu
- Department of Bioengineering, Clemson University, Clemson, SC, USA
- Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - S. E. Cisewski
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - F. Wei
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - X. She
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - T. S. Gonzales
- Department of Oral Health Sciences, MUSC, Charleston, SC, USA
| | - L. R. Iwasaki
- Department of Orthodontics and Dentofacial Orthopaedics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - J. C. Nickel
- Department of Orthodontics and Dentofacial Orthopaedics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - H. Yao
- Department of Bioengineering, Clemson University, Clemson, SC, USA
- Department of Orthopaedics, Medical University of South Carolina (MUSC), Charleston, SC, USA
- Department of Oral Health Sciences, MUSC, Charleston, SC, USA
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13
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Kohinata K, Matsumoto K, Suzuki T, Tsunoda M, Hayashi Y, Araki M, Hashimoto K, Honda K. Retrospective magnetic resonance imaging study of risk factors associated with sideways disk displacement of the temporomandibular joint. J Oral Sci 2017; 58:29-34. [PMID: 27021537 DOI: 10.2334/josnusd.58.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
As part of our ongoing investigation of risk and predictive factors associated with temporomandibular disorders, we used magnetic resonance imaging (MRI) to identify risk factors for sideways disk displacement of the temporomandibular joint in 26 patients with MRI-confirmed unilateral pure sideways disk displacement (medial or lateral disk displacement) and normal positioning of the contralateral temporomandibular joint. Coronal morphologic harmonization between the condyle and fossa, angle between the axis of the ramus and condyle, and angle between the lateral pterygoid muscle (LPM) and condyle were evaluated. Only angle of the LPM related to the condyle was significantly correlated with mediolateral disk position; the angles of joints with medial, normal, and lateral disk positions were 70.2°, 66.7°, and 60.1°, respectively. These results suggest that a greater angle of the inferior head of the LPM to the axis of the condyle on axial MRI images may cause medial disk displacement, while a smaller angle may result in lateral disk displacement. (J Oral Sci 58, 29-34, 2016).
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Affiliation(s)
- Kiyomi Kohinata
- Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry
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Litko M, Szkutnik J, Berger M, Różyło-Kalinowska I. Correlation between the lateral pterygoid muscle attachment type and temporomandibular joint disc position in magnetic resonance imaging. Dentomaxillofac Radiol 2016; 45:20160229. [PMID: 27506381 DOI: 10.1259/dmfr.20160229] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the correlation between the lateral pterygoid muscle (LPM) attachment type and temporomandibular joint (TMJ) disc position on sagittal and coronal MR scans. METHODS 191 patients (148 females, 43 males), aged 14-60 years, underwent MR investigations of the TMJs in the intercuspal position (IP) and open-mouth position (OMP). The disc position was evaluated on oblique sagittal and coronal images in the IP and OMP on many MRI sections showing all portions of the joint. Relationships between the LPM attachment patterns and articular disc positions were evaluated by z and χ2 tests. RESULTS Three types of the LPM attachment were found. There was a statistically significant correlation between the LPM attachment type and the disc position in IP (χ2 = 24.29; p < 0.01). The type of muscle attachment did not determine the prevalence of normal, lateral and medial disc positions. There were differences between the muscle attachment types in the anterior, anteromedial and anterolateral disc positions. There was a statistically significant association between TMJ disc position in OMP and particular attachment types in the sagittal plane (χ2 = 9.702; p < 0.01). CONCLUSIONS Certain types of the LPM insertion are correlated with TMJ disc position.
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Affiliation(s)
- Monika Litko
- 1 Department of Functional Masticatory Disorders, Medical University of Lublin, Lublin, Poland
| | - Jacek Szkutnik
- 1 Department of Functional Masticatory Disorders, Medical University of Lublin, Lublin, Poland
| | - Marcin Berger
- 1 Department of Functional Masticatory Disorders, Medical University of Lublin, Lublin, Poland
| | - Ingrid Różyło-Kalinowska
- 2 Independent Unit of Propedeutics of Dentomaxillofacial Radiology, Medical University of Lublin, Lublin, Poland
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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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Evaluating the correlation between the lateral pterygoid muscle attachment type and internal derangement of the temporomandibular joint with an emphasis on MR imaging findings. J Craniomaxillofac Surg 2012; 40:459-63. [DOI: 10.1016/j.jcms.2011.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/31/2011] [Accepted: 08/02/2011] [Indexed: 11/20/2022] Open
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Davies J, Charles M, Cantelmi D, Liebgott B, Ravichandiran M, Ravichandiran K, Agur A. Lateral pterygoid muscle: A three-dimensional analysis of neuromuscular partitioning. Clin Anat 2011; 25:576-83. [DOI: 10.1002/ca.21298] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 09/22/2011] [Accepted: 10/11/2011] [Indexed: 11/11/2022]
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Hannam AG. Current computational modelling trends in craniomandibular biomechanics and their clinical implications. J Oral Rehabil 2010; 38:217-34. [PMID: 20819138 DOI: 10.1111/j.1365-2842.2010.02149.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Computational models of interactions in the craniomandibular apparatus are used with increasing frequency to study biomechanics in normal and abnormal masticatory systems. Methods and assumptions in these models can be difficult to assess by those unfamiliar with current practices in this field; health professionals are often faced with evaluating the appropriateness, validity and significance of models which are perhaps more familiar to the engineering community. This selective review offers a foundation for assessing the strength and implications of a craniomandibular modelling study. It explores different models used in general science and engineering and focuses on current best practices in biomechanics. The problem of validation is considered at some length, because this is not always fully realisable in living subjects. Rigid-body, finite element and combined approaches are discussed, with examples of their application to basic and clinically relevant problems. Some advanced software platforms currently available for modelling craniomandibular systems are mentioned. Recent studies of the face, masticatory muscles, tongue, craniomandibular skeleton, temporomandibular joint, dentition and dental implants are reviewed, and the significance of non-linear and non-isotropic material properties is emphasised. The unique challenges in clinical application are discussed, and the review concludes by posing some questions which one might reasonably expect to find answered in plausible modelling studies of the masticatory apparatus.
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Affiliation(s)
- A G Hannam
- Faculty of Dentistry, Department of Oral Health Sciences, The University of British Columbia, Vancouver, BC, Canada.
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Nishio C, Tanimoto K, Hirose M, Horiuchi S, Kuroda S, Tanne K, Tanaka E. Stress analysis in the mandibular condyle during prolonged clenching: a theoretical approach with the finite element method. Proc Inst Mech Eng H 2009; 223:739-48. [PMID: 19743639 DOI: 10.1243/09544119jeim485] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Parafunctional habits, such as bruxism and prolonged clenching, have been associated with functional overloading in the temporomandibular joint (TMJ), which may result in internal derangement and osteoarthrosis of the TMJ. In this study, the distributions of stress on the mandibular condylar surface during prolonged clenching were examined with TMJ mathematical models. Finite element models were developed on the basis of magnetic resonance images from two subjects with or without anterior disc displacement of the TMJ. Masticatory muscle forces were used as a loading condition for stress analysis during a 10 min clenching. In the asymptomatic model, the stress values in the anterior area (0.100 MPa) and lateral area (0.074 MPa) were relatively high among the five areas at 10 min. In the middle and posterior areas, stress relaxation occurred during the first 2 min. In contrast, the stress value in the lateral area was markedly lower (0.020 MPa) than in other areas in the symptomatic model at 10 min. The largest stress (0.050 MPa) was located in the posterior area. All except the anterior area revealed an increase in stress during the first 2 min. The present result indicates that the displacement of the disc could affect the stress distribution on the condylar articular surface during prolonged clenching, especially in the posterior area, probably leading to the cartilage breakdown on the condylar articular surface.
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Affiliation(s)
- C Nishio
- Department of Orthodontics and Craniofacial Development Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Koolstra JH, Tanaka E. Tensile stress patterns predicted in the articular disc of the human temporomandibular joint. J Anat 2009; 215:411-6. [PMID: 19627392 DOI: 10.1111/j.1469-7580.2009.01127.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The direction of the first principal stress in the articular disc of the temporomandibular joint was predicted with a biomechanical model of the human masticatory system. The results were compared with the orientation of its collagen fibers. Furthermore, the effect of an active pull of the superior lateral pterygoid muscle, which is directly attached to the articular disc, was studied. It was hypothesized that the markedly antero-posterior direction of the collagen fibers would be reflected in the direction of the tensile stresses in the disc and that active pull of the superior lateral pterygoid muscle would augment these tensions. It was found that the tensile patterns were extremely dependent on the stage of movement and on the mandibular position. They differed between the superior and inferior layers of the disc. The hypothesis could only be confirmed for the anterior and middle portions of the disc. The predicted tensile principal stresses in the posterior part of the disc alternated between antero-posterior and medio-lateral directions.
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Affiliation(s)
- J H Koolstra
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
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