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Langie R, Pacheco VN, Szydloski VM, Corsetti A, de Quevedo AS, da Silva FP, Collares FM, Visioli F, Ponzoni D, Puricelli E. Puricelli biconvex arthroplasty: an experimental study in sheep. Head Face Med 2023; 19:33. [PMID: 37528466 PMCID: PMC10394908 DOI: 10.1186/s13005-023-00379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The aim of this study was to establish a sheep model of the Puricelli biconvex arthroplasty (ABiP) technique in sheep for evaluating its functional, biological and histological parameters. METHODS Ten Corriedale black sheep were submitted to TMJ total reconstruction with poly(methyl methacrylate) (PMMA) using ABiP and euthanized after 45 (n = 5) or 90 (n = 5) days. Control animals (n = 2) underwent sham operations and were euthanized after 45 days. Variables were assessed before the surgery (T0), immediately after (T1) and at 45 or 90 postoperative days (T2). RESULTS Histological analyses showed regression of inflammatory cells over the follow-up period. PMMA showed reduced porosity and roughness in the articular contact area. PMMA temporal components showed linear and volumetric wear in comparison to control, but no foreign body reaction was observed. The reconstructions were stable in all animals. The amplitude of mouth opening and left lateral movements were maintained, except for a reduction in the range of right lateral movements at day 90 in the experimental group. Clinical, macroscopic and radiographic observations showed that the reconstructions were stable. CONCLUSIONS The analysis of functional, biological and histological parameters in sheep submitted to ABiP showed stable results of the procedure, with maintenance of body weight and all mandibular movements, save contralateral mandibular movement, suggesting that joint function was completely maintained following the procedure. This experimental study provides support for clinical results previously reported of the ABiP technique in TMJ reconstruction procedures.
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Affiliation(s)
- Renan Langie
- Department of Surgery and Orthopedics, School of Dentistry / Unit of Oral and Maxillofacial Surgery, Clinics Hospital of Porto Alegre - University Hospital, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Department of Oral and Maxillofacial Surgery, Santa Casa de Misericórdia de Porto Alegre (SCMPA), Porto Alegre, RS, Brazil.
- Department of Oral and Maxillofacial Surgery, Düsseldorf University Hospital (UKD), Henrich-Heine University (HHU), Düsseldorf, NRW, Germany.
| | - Viviane Neves Pacheco
- Department of Surgery and Orthopedics, School of Dentistry / Unit of Oral and Maxillofacial Surgery, Clinics Hospital of Porto Alegre - University Hospital, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Vinicius Matheus Szydloski
- Department of Surgery and Orthopedics, School of Dentistry / Unit of Oral and Maxillofacial Surgery, Clinics Hospital of Porto Alegre - University Hospital, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
- Department of Oral and Maxillofacial Surgery, Santa Casa de Misericórdia de Porto Alegre (SCMPA), Porto Alegre, RS, Brazil
| | - Adriana Corsetti
- Department of Surgery and Orthopedics, School of Dentistry / Unit of Oral and Maxillofacial Surgery, Clinics Hospital of Porto Alegre - University Hospital, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Alexandre Silva de Quevedo
- Department of Surgery and Orthopedics, School of Dentistry / Unit of Oral and Maxillofacial Surgery, Clinics Hospital of Porto Alegre - University Hospital, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fábio Pinto da Silva
- Laboratory of Design and Material Selection (LDSM), School of Engineering, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fabrício Mezzomo Collares
- Laboratory of Dental Materials (LAMAD), School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernanda Visioli
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Deise Ponzoni
- Department of Surgery and Orthopedics, School of Dentistry / Unit of Oral and Maxillofacial Surgery, Clinics Hospital of Porto Alegre - University Hospital, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Edela Puricelli
- Department of Surgery and Orthopedics, School of Dentistry / Unit of Oral and Maxillofacial Surgery, Clinics Hospital of Porto Alegre - University Hospital, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
- Department of Oral and Maxillofacial Surgery, Santa Casa de Misericórdia de Porto Alegre (SCMPA), Porto Alegre, RS, Brazil
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Puricelli E. Puricelli biconvex arthroplasty as an alternative for temporomandibular joint reconstruction: description of the technique and long-term case report. Head Face Med 2022; 18:27. [PMID: 35906643 PMCID: PMC9335964 DOI: 10.1186/s13005-022-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up. Case presentation In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components. Conclusions The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis.
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Affiliation(s)
- Edela Puricelli
- Oral and Maxillofacial Surgery Unit/ Clinical Hospital of Porto Alegre (HCPA), School of Dentistry/Federal University of Rio Grande Do Sul (UFRGS), Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
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Fratzl-Zelman N, Roschger P, Kang H, Jha S, Roschger A, Blouin S, Deng Z, Cabral WA, Ivovic A, Katz J, Siegel RM, Klaushofer K, Fratzl P, Bhattacharyya T, Marini JC. Melorheostotic Bone Lesions Caused by Somatic Mutations in MAP2K1 Have Deteriorated Microarchitecture and Periosteal Reaction. J Bone Miner Res 2019; 34:883-895. [PMID: 30667555 PMCID: PMC8302214 DOI: 10.1002/jbmr.3656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/28/2022]
Abstract
Melorheostosis is a rare non-hereditary condition characterized by dense hyperostotic lesions with radiographic "dripping candle wax" appearance. Somatic activating mutations in MAP2K1 have recently been identified as a cause of melorheostosis. However, little is known about the development, composition, structure, and mechanical properties of the bone lesions. We performed a multi-method phenotype characterization of material properties in affected and unaffected bone biopsy samples from six melorheostosis patients with MAP2K1 mutations. On standard histology, lesions show a zone with intensively remodeled osteonal-like structure and prominent osteoid accumulation, covered by a shell formed through bone apposition, consisting of compact multi-layered lamellae oriented parallel to the periosteal surface and devoid of osteoid. Compared with unaffected bone, melorheostotic bone has lower average mineralization density measured by quantitative backscattered electron imaging (CaMean: -4.5%, p = 0.04). The lamellar portion of the lesion is even less mineralized, possibly because the newly deposited material has younger tissue age. Affected bone has higher porosity by micro-CT, due to increased tissue vascularity and elevated 2D-microporosity (osteocyte lacunar porosity: +39%, p = 0.01) determined on quantitative backscattered electron images. Furthermore, nano-indentation modulus characterizing material hardness and stiffness was strictly dependent on tissue mineralization (correlation with typical calcium concentration, CaPeak: r = 0.8984, p = 0.0150, and r = 0.9788, p = 0.0007, respectively) in both affected and unaffected bone, indicating that the surgical hardness of melorheostotic lesions results from their lamellar structure. The results suggest a model for pathophysiology of melorheostosis caused by somatic activating mutations in MAP2K1, in which the genetically induced gradual deterioration of bone microarchitecture triggers a periosteal reaction, similar to the process found to occur after bone infection or local trauma, and leads to an overall cortical outgrowth. The micromechanical properties of the lesions reflect their structural heterogeneity and correlate with local variations in mineral content, tissue age, and remodeling rates, in the same way as normal bone. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Nadja Fratzl-Zelman
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK, and AUVA Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK, and AUVA Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Heeseog Kang
- Section on Heritable Disorders of Bone and Extracellular Matrix, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Smita Jha
- Clinical and Investigative Orthopedics Surgery Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.,Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Andreas Roschger
- Max Planck Institute of Colloids and Interfaces, Department of Biomaterials, Potsdam, Germany
| | - Stéphane Blouin
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK, and AUVA Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Zuoming Deng
- Biodata Mining and Discovery Section, Office of Science and Technology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Wayne A Cabral
- Section on Heritable Disorders of Bone and Extracellular Matrix, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Aleksandra Ivovic
- Immunoregulation Section, Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - James Katz
- Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Richard M Siegel
- Immunoregulation Section, Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK, and AUVA Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Peter Fratzl
- Max Planck Institute of Colloids and Interfaces, Department of Biomaterials, Potsdam, Germany
| | - Timothy Bhattacharyya
- Clinical and Investigative Orthopedics Surgery Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Joan C Marini
- Section on Heritable Disorders of Bone and Extracellular Matrix, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Puricelli E, Artuzi FE, Ponzoni D, Quevedo AS. Condylotomy to Reverse Temporomandibular Joint Osteoarthritis in Rabbits. J Oral Maxillofac Surg 2019; 77:2230-2244. [PMID: 31128080 DOI: 10.1016/j.joms.2019.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Osteoarthritis (OA) of the temporomandibular joint (TMJ) is characterized by local tissue degeneration and pain. Treatments have been aimed at reducing symptoms, and only some can interfere with the progression of pathophysiologic changes caused by OA. Condylotomy is an alternative treatment for patients with OA refractory to conventional treatment. The aim of the present animal study was to investigate the influence of condylotomy on TMJ OA in New Zealand rabbits. MATERIALS AND METHODS The 36 rabbits were divided into 3 groups: the osteoarthritis group (OG; induced OA), treatment group (TG; induced OA plus condylotomy), and control group (CG; neither OA nor surgery). OA was induced using intra-articular monosodium iodoacetate injection for 40 days. The rabbits in the TG underwent condylotomy and were killed 20, 40, and 60 days after treatment. The rabbits in the CG and OG were killed at the same points. RESULTS The articular joint condition was better in the TG 60 days after surgery (P = .032). A direct comparison revealed regression of TMJ OA over time among the treated rabbits (P = .008). Surgical treatment promoted mandibular condylar remodeling in the TG, reversing the tissue degeneration caused by OA. CONCLUSIONS Our findings suggest that condylotomy could be an option for the treatment of OA and prevent damage to TMJ structures. This could be of particular importance for patients without satisfactory responses to more conservative treatment.
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Affiliation(s)
- Edela Puricelli
- Full Professor, Universidade Federal do Rio Grande do Sul; Oral and Maxillofacial Surgery Unit, Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Ernesto Artuzi
- Surgeon, Oral and Maxillofacial Surgery Unit, Hospital de Clínicas de Porto Alegre; Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Deise Ponzoni
- Associate Professor, Universidade Federal do Rio Grande do Sul; Head, Oral and Maxillofacial Surgery Unit, Hospital de Clínicas de Porto Alegre; Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alexandre Silva Quevedo
- Assistant Professor, Universidade Federal do Rio Grande do Sul; Graduate Program in Neuroscience, Universidade Federal do Rio Grande do Sul, School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil
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Effect of human adipose-derived regenerative cells on temporomandibular joint healing in immunodeficient rabbits. ACTA VET BRNO 2019. [DOI: 10.2754/avb201988010049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increasing research attention has focused on the use of stem cells (SCs) in regenerative and reparative medicine. Adipose-derived regenerative cells (ADRCs) are a relatively cheap and ethical source of SCs. Temporomandibular disorders (TMDs) have been reported with rising incidence over recent decades. The main aims of this study were to evaluate the effects of ADRCs application on the healing of both soft and hard temporomandibular joint (TMJ) tissues, and to assess the possible utilization of ADRCs in TMD treatment. We investigated the effects of human ADRCs on the healing of TMJ defects in immunodeficient rabbits. With no prior cultivation, ADRCs were applied to a surgically created defect in the cartilage of a rabbit TMJ. The healing process and inflammatory response were examined. Our results indicated that ADRCs supported repair processes in soft tissues. However, ADRC treatment induced a significant immune response in both soft and hard tissues, with hard tissues showing a higher level of bone remodelling. Non-differentiated ADRCs can be a promising tool for regenerative medicine of TMJ; however, deeper understanding of their effect on the cellular level is needed.
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