Histologic effects of mandibular protrusion splints in antigen-induced TMJ arthritis in rabbits

Julia Von Bremen,Sabine Ruf,Kernt Köhler,Daniel Zahner,Krystyna Siudak

doi:10.1186/s12969-017-0158-0

Julia Von Bremen, Sabine Ruf + Show 3 more

Open Access

https://doi.org/10.1186/s12969-017-0158-0

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Abstract

BackgroundAlthough it is common clinical practice to treat children with Juvenile Idiopathic Arthritis (JIA) with functional appliances, the scientific evidence for this is limited. The aim of this study was to study the histologic effects of mandibular protrusion splints in temporomandibular joint (TMJ) arthritis in rabbits.MethodsTwenty-eight ten-week old New Zealand white rabbits were randomly divided into four groups: AO (TMJ arthritis, no splint), AS (TMJ arthritis, mandibular splint advancement), OS (no arthritis, mandibular splint advancement) and OO (no arthritis, no splint). TMJ arthritis was induced in the groups AO and AS; 1 week later mandibular protrusion splints were placed on the upper incisors of the AS and OS animals. After 60 days the animals were sacrificed and a semiquantitative histologic evaluation of each TMJ was carried out to analyze the amount of inflammation and bone modeling.ResultsAO and AS animals had a higher inflammation score (AO = 1.3; AS = 1.8) than the non-arthritis groups (OO = 0.6; OS = 0.4). Whereas in the untreated control (OO) the amount of apposition and resorption was almost in balance (+1), OS animals displayed significantly more apposition (+9) and AO animals significantly more resorption (−3) than the untreated control. Arthritis animals with protrusion appliances (AS), however, had remarkably more bone apposition (+3) than resorption, indicating a similar bony reaction as in healthy animals, although reduced in extent.ConclusionsMandibular advancement in rabbits with TMJ arthritis is possible without detrimental histologic reactions and appears to partially compensate for the bone loss seen in rabbits with TMJ arthritis but without protrusion splints.

Highlights

It is common clinical practice to treat children with Juvenile Idiopathic Arthritis (JIA) with functional appliances, the scientific evidence for this is limited
Results two animals of the A0 group were lost during induction of the temporomandibular joint (TMJ) arthritis: the first due to respiratory arrest under general anesthesia, the second due to an anaphylactic shock
On average the 0S-animals had slightly lower values (0.4) than the 00 group (0.6), whereas in comparison of the two arthritis groups higher values were found for the animals with protrusion appliances (AS = 1.8) than for those without mandibular protrusion (A0 = 1.3) (Table 3)

Summary

Introduction

It is common clinical practice to treat children with Juvenile Idiopathic Arthritis (JIA) with functional appliances, the scientific evidence for this is limited. The prevalence of clinically detectable temporomandibular joint (TMJ) involvement varies between 38 and 72%, depending on the diagnostic method used and the JIA-subtype examined [2,3,4,5,6,7,8]. This TMJ inflammation may cause significant limitations in sagittal and vertical mandibular growth, conditionally resulting in severe micrognathia and anterior. It appears to be clinically possible to enhance growth in JIA children with TMJ involvement to a certain extent and von Bremen et al Pediatric Rheumatology (2017) 15:27 partially compensate for the growth limitations caused by the inflammatory process [22,23,24]

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