Articular Disc Research Articles

Complex Treatment of Internal TMJ Disorders in Patients with Different Bit Types

Objective: To assess the impact of physiological and pathological types of occlusion on the effectiveness of the treatment of patients with internal disorders of the TMJ. Material and Methods: A comprehensive examination and treatment of 139 patients with internal TMJ disorders with subluxation and chronic dislocation of the articular disc was carried out. The patients were divided into three groups. All groups included patients with both physiological and pathological occlusion. The first group included 28 (20.1%) patients who were treated only with occlusal splint therapy; the second group included 95 (68.3%) patients who were treated with a combination of occlusal splint therapy and the use of arthrocentesis; in the third group (16 people (11.5%), along with splint therapy and arthrocentesis, TMJ arthroscopy was performed. The examination included a survey and examination of patients, a study of diagnostic models of the jaws to determine the types of occlusion and occlusal contacts, magnetic resonance imaging (MRI) and ultrasound examination (ultrasound) of the TMJ. Patients underwent a phased treatment, including occlusive splint therapy (stage I); with insufficient effectiveness - occlusive splint therapy and arthrocentesis (stage II); occlusive splint therapy and arthrocentesis in combination with arthroscopy (stage III of treatment). Results: As a result of the study, it turned out that the groups of patients differed significantly in the complexity and duration of the treatment. Thus, in patients with internal TMJ disorders and pathological type of occlusion, in 82.6% of cases, additional use of arthrocentesis was required and in 34.8% - arthroscopy (95 patients out of 139), while patients with physiological types of occlusion (orthognathic, progenic, biprogenic and direct) needed these treatments in 80.2% and 7.8% of cases, respectively In the groups of patients, the duration of therapy, as well as the number of arthrocentesis performed in patients at the second and third stages of treatment, significantly differed. In the first group, the duration of treatment was 6.2 months for patients with normal occlusion and 8.7 (p<0.01) months for patients with pathological occlusion; additional methods of treatment (arthrocentesis and arthroscopy) were not used. In the second and third groups of patients, the duration of treatment for patients with occlusion pathology was also longer: in the second group 4.9 and 6.8 (p<0.01) months for patients with physiological and pathological types of occlusion, respectively, in the third group with the use of splint therapy, arthrocentesis and arthroscopy in patients with normal occlusion was 13.1 (p<0.05) months, and in patients with occlusion pathology 14.5 months Conclusion: Patients with internal TMJ disorders need a comprehensive examination for the timely detection of occlusion pathologies. The relationship between internal TMJ disorders and the type of occlusion must always be taken into account in the choice of further treatment tactics and therapy planning in order to achieve the best result.

Arthroscopic osteoplasty of the medial and anteromedial wall of temporomandibular joint: surgical technique and anatomical considerations

The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely common pathology, there is no certainty about the aetiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the aetiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease. All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our centre from January 2021 to September 2021 were reviewed and analysed to identify specific anatomical features observed in every procedure. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most common complication observed in our sample was the dysaesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n = 2), intraoperative bleeding (n = 1), and postoperative malocclusion (n = 1). The compression of the superior head of pterygoid lateral muscle (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the aetiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle allows a remodelling of the bone surfaces with minimal complications

Temporomandibular joint segmentation in MRI images using deep learning

ObjectivesTemporomandibular joint (TMJ) internal derangements (ID) represent the most prevalent temporomandibular joint disorder (TMD) in the population and its diagnosis typically relies on magnetic resonance imaging (MRI). TMJ articular discs in MRIs usually suffer from low resolution and contrast, and it is difficult to identify them. In this study, we applied two convolutional neural networks (CNN) to delineate mandibular condyle, articular eminence, and TMJ disc in MRI images. MethodsThe models were trained on MRI images from 100 patients and validated on images from 40 patients using 2D slices and 3D volume as input, respectively. Data augmentation and five-fold cross-validation scheme were applied to further regularize the models. The accuracy of the models was then compared with four raters having different expertise in reading TMJ-MRI images to evaluate the performance of the models. ResultsBoth models performed well in segmenting the three anatomical structures. A Dice coefficient of about 0.7 for the articular disc, more than 0.9 for the mandibular condyle, and Hausdorff distance of about 2mm for the articular eminence were achieved in both models. The models reached near-expert performance for the segmentation of TMJ articular disc and performed close to the expert in the segmentation of mandibular condyle and articular eminence. They also surpassed non-experts in segmenting the three anatomical structures. ConclusionThis study demonstrated that CNN-based segmentation models can be a reliable tool to assist clinicians identifying key anatomy on TMJ-MRIs. The approach also paves the way for automatic diagnosis of TMD. Clinical significanceAccurately locating the articular disc is the hardest and most crucial step in the interpretation of TMJ-MRIs and consequently in the diagnosis of TMJ-ID. Automated software that assists in locating the articular disc and its surrounding structures would improve the reliability of TMJ-MRI interpretation, save time and assist in reader training. It will also serve as a foundation for additional automated analysis of pathology in TMJ structures to aid in TMD diagnosis.

Temporomandibular Joint Disk Displacement: Etiology, Diagnosis, Imaging, and Therapeutic Approaches.

An estimated 8 to 15% of women, and 3 to 10% of men currently suffer from Temporomandibular disorders, and it has been reported that sounds are a common finding and have been observed in 28% to 50% of the adult population; sounds are almost always connected to "internal derangements" a condition in which the articular disk displaced from its position on the mandibular condyle. Due to the multifactorial etiology of temporomandibular joint dysfunction, any accurate diagnosis based on clinical examination alone often proves to be difficult, so a clinical examination should be utilized together with other imaging methods to determine the relationship between the disk and condyle before and after treatment. In general, management of temporomandibular joint-related conditions is necessary when pain or dysfunction is present, so many surgical or nonsurgical methods of treatment have been reported. The Occlusal splint is 1 of the most widespread treatment it induces a slight vertical condylar distraction and eliminates the occlusal factor, which can be responsible for Temporomandibular joint disturbances, removing the influence of the teeth on the joint position by the slight distraction of the joint which, in turn, enables damaged connective tissue to heal.

Contribution of magnetic resonance imaging in the biomechanical interpretation of the temporomandibular joint. Clinical case report

X-rays and tomography, in their different modalities, are used as auxiliary diagnostic elements in temporomandibular joint (TMJ) dysfunction, both in static and dynamic situations; however, because they only allow the observation of bone structures, magnetic resonance imaging (MRI) is the ideal method to analyze, among other structures, the articular disc. Among the internal disorders of the TMJ are the abnormal postural relationships between the disc, mandibular head, fossa and articular tubercle, which can even lead to a musculoskeletal condition causing noise, pain and functional limitation. The clinical evaluation of temporomandibular dysfunctions is complex, especially in asymptomatic patients; the Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), place these entities within the AXIS I protocol, considering that the image is not strictly necessary. However, analyzing the disc situation statically and dynamically, with its surroundings, allows considering the loads that generate dysfunction, leading to the correct diagnosis, and selection of the best treatment. A clinical case is presented, an asymptomatic patient, without functional limitation, who reported a history of occasional mouth opening locking upon awakening. MRI was indicated, finding an abnormal position of the disc, in a static and dynamic situation; finding anterior displacement of the disc in the right and left TMJ in closed mouth position, dynamically anterior displacement without recapture in the right TMJ and with recapture in the left TMJ; Treatment was performed with Jaw Functional Orthopedics (JFO), obtaining changes in the dynamic disc-mandibular head relationship, anterior displacement with recapture of the right TMJ and total recapture of the left TMJ.

Addressing Practical Issues in Atomic Force Microscopy-Based Micro-indentation on Human Articular Cartilage Explants

Without a doubt, atomic force microscopy (AFM) is currently one of the most powerful and useful techniques to assess micro and even nano-cues in the biological field. However, as with any other microscopic approach, methodological challenges can arise. In particular, the characteristics of the sample, sample preparation, type of instrument, and indentation probe can lead to unwanted artifacts. In this protocol, we exemplify these emerging issues on healthy as well as osteoarthritic articular cartilage explants. To this end, we first show via a step-by-step approach how to generate, grade, and visually classify ex vivo articular cartilage discs according to different stages of degeneration by means of large 2D mosaic fluorescence imaging of the whole tissue explants. The major strength of the ex vivo model is that it comprises aged, native, human cartilage that allows the investigation of osteoarthritis-related changes from early onset to progression. In addition, common pitfalls in tissue preparation, as well as the actual AFM procedure together with the subsequent data analysis, are also presented. We show how basic but crucial steps such as sample preparation and processing, topographic sample characteristics caused by advanced degeneration, and sample-tip interaction can impact data acquisition. We also subject to scrutiny the most common problems in AFM and describe, where possible, how to overcome them. Knowledge of these limitations is of the utmost importance for correct data acquisition, interpretation, and, ultimately, the embedding of findings into a broad scientific context.

The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement.

Temporomandibular disorders are musculoskeletal conditions characterized by facial pain and impaired temporomandibular joint function, limited mouth opening, joint and muscular pain, and noises during mandibular movements are some of the most common symptoms. The most frequent cause of temporomandibular joint dysfunction is internal derangement (ID), which refers to an alteration in the normal pathways of motion of the joint that largely involves the function of the articular disc, therefore, these alterations have been also referred to as disc derangement. Arthrocentesis is a minimally invasive technique, less expensive than surgical treatment. Adhesions are released after arthrocentesis of the upper joint space under sufficient hydraulic pressure. Intra-articular ozone gas injection is used as conservative treatment modalities for ID of the temporomandibular as it possesses anti-inflammatory, analgesic effects, enhancement the host defense mechanism and accelerates the healing process of the damaged cells. The aim of this study was to compare the effectiveness of ozonized water against lactated ringer solution in the arthrocentesis of the temporomandibular joint. Sixty patients were used in this study, suffered from ID of the temporomandibular joint treated by arthrocentesis under hydraulic pressure and were allocated into 2 groups; the study group (A), which included 30 patients, managed by arthrocentesis utilizing ozonized water and the control group (B) with 30 patients also treated by the same procedure using ringer lactate solution. Visual analog scale pain scores, temporomandibular joint sounds, and maximal mouth opening were assessed preoperatively and at different intervals postoperatively. The age in this study ranged from 14 to 66 years. The mean age of group A was 29.93 years with an SD of ±11.79. For group B, the mean age was 27.56 years and the SD was ±10.80, the prominent percentage in both groups was < 30 years. Regarding sex, 45 patients were females, whereas the males were 15 with a ratio of 3:1. Group A registered the highest reduction in the visual analog scale at all postoperative intervals. With respect to the mouth opening, there was no significant difference in maximal mouth opening between the 2 groups after 1 week and 12 weeks in comparison with the preoperative measurements. The temporomandibular joint sounds improved in all patients in group A after 12 weeks, whereas in group B the sounds dropped to 33.3%. The data from the present study suggested more favorable treatment outcomes for ozonized water lavage and it is a promising new treatment modality for the relief of symptoms associated with the ID of the temporomandibular joint.

Relationship between gonial angle and articular disk position of the temporomandibular joints: A retrospective study

AbstractPurposeMagnetic resonance imaging (MRI) is frequently used to diagnose temporomandibular joint disease. However, very few studies have assessed the relationship between the mandibular gonial angle and temporomandibular joint (TMJ) disorders using panoramic radiography and MRI. The aim of this study was to assess the relationship between the gonial angle and articular disk position of the TMJs using panoramic radiography and MRI.Material and methodThe patients underwent panoramic radiography and MRI simultaneously at a university hospital between April 2017 and March 2018. We analyzed the records of 109 patients with and without disc displacement. Among these, 88 patients had disc displacement of the TMJ, while 21 patients were normal. The variable “mean mandibular gonial angle” was evaluated as a predictor. The primary outcome was the presence or absence of disc displacement in the TMJs. The other variables included sex and age. Data were analyzed using Spearman's rank correlation coefficient, the Mann–Whitney U test, and receiver operating characteristic (ROC) curves. Statistical significance was set at P &lt; 0.05.ResultsThere was no significant difference between men and women in mean gonial angle, and there was no correlation with age (P &gt; 0.05). Moreover, the mean mandibular gonial angle in the disc displacement group was significantly higher than that in the nondisc displacement group (P &lt; 0.01). ROC analysis revealed a cutoff mandibular gonial angle of 120.23° for predicting the development of disc displacement.ConclusionsMandibular gonial angle is a useful parameter for predicting disc displacement of the TMJs.

Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up.

Background: The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. Methods: Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. Results: Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. Conclusions: A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

TMJ disc repositioning associated with orthognathic surgery for the treatment of severe retrognathism

Introduction: Orthognathic surgery associated with temporomandibular disc reposition is a modality of surgical treatment for dentofacial deformities associated with temporomandibular disorders that has been shown to be a stable and predictable alternative for such situations. However, there is still no consensus in the literature regarding the treatment modality in these cases. Several studies have been developed looking for more stable and predictable results in favor of the best patient treatment. Case Report: Patient with a class II facial pattern and temporomandibular dysfunction, submitted to bilateral repositioning of the articular disc and orthognathic surgery with counterclockwise rotation of the maxillomandibular complex, with improvement of the symptoms and of the functionality of the stomatognathic system, and satisfaction with facial aesthetics. Conclusion: Although there are controversies about the surgical repositioning of chronic articular disc displacements in retrognathism, this treatment modality has demonstrated long-term stability and reduction or resolution of joint symptoms.

Morphologic Analysis of Condyle among Different Disc Status in the Temporomandibular Joints by Three-dimensional Reconstructive Imaging: A Preliminary Study

ObjectivesMorphological study is a common approach in the field of anterior disc displacement (ADD) pathology; however, analysis based on three-dimensional reconstructive imaging has not been investigated. This study investigated the association between ADD and the status of the mandibular condyle and articular fossa.MethodsThirty-four patients were divided into three groups: normal articular disc position (NADP), anterior disc displacement with reduction (ADDwR), and anterior disc displacement without reduction (ADDwoR). Multiple grouped comparisons of three different disc statuses were performed by Kruskal–Wallis H test and variance analysis respectively. Receiver-operating characteristic curve was plotted to assess the diagnostic efficacy of the morphological parameters. Multivariate logistic regression analysis was used to investigate the interfering factors of ADD.ResultsThe condylar volume (CV) and condylar superficial area (CSA) in the NADP, ADDwR, and ADDwoR groups exhibited obvious changes (P < 0.05). Both CV and superior joint space (SJS) presented a good diagnostic accuracy for NADP-ADDwoR [area under the curve (AUC)CV = 0.813; AUCSJS = 0.855)], and ADDwR-ADDwoR (AUCCV = 0.858; AUCSJS = 0.801). CSA presented a good diagnostic accuracy for ADDwR-ADDwoR (AUC = 0.813). A multivariate logistic ordinal regression model showed that the CV [odds ratio (OR) = 1.011; regression coefficient (RC) = 0.011, P = 0.018], SJS (OR, 8.817; RC = 2.177; P < 0.001), and medial joint space (MJS) (OR, 1.492; RC = 0.400; P = 0.047) had a significantly impact on the groups.ConclusionCV, CSA, SJS, and MJS were significantly associated with the different disc status, and the condyle in ADD exhibited 3-dimensionally altered dimensions. They could be considered as promising biometric markers to assess the ADD.

Dynamic 3D images fusion of the temporomandibular joints: A novel technique

ObjectivesTo demonstrate a procedure for fusing images from cone-beam computed tomography (CBCT), magnetic resonance imaging (MRI) and optical positioning tracking system to dynamically evaluate the relative motion of the temporomandibular joint (TMJ) for the diagnosis of temporomandibular disorders (TMD). MethodsCBCT data was collected from a patient wearing a fixation device with markers in the intercuspal position. The patient's mandibular movements were recorded using an optical positioning tracking system. The CBCT data were imported into a virtual simulation system to reproduce the mandibular movement. Five jaw positions were selected for 3D printing of the occlusal plate that the patient wore to undergo MRI. MRI scans were registered with the CBCT image for fusion and reconstruction. ResultsThe anatomical structures of the articular fossa, articular disc, and condyle were clearly displayed in the CBCT-MRI fused images. The spatial posture and relative position of the fossa-disc-condyle during mandibular movement could be reproduced dynamically using the 3D reconstruction model. ConclusionsThis method can visually display mandibular motion trajectories and the relative TMJ positions. Virtual reproduction provides a comprehensive understanding of the articular disc's morphology and position in different states from a 3D perspective. Clinical SignificanceThis method can be used in clinical studies of TMJ as an adjunct to the 3D dynamic diagnosis and assessment for complex patients with TMD and provide relevant data for doctors.

The pressure in the temporomandibular joint in the patients with maxillofacial deformities

BackgroundTemporomandibular disorder (TMD) symptoms were found to be common in the patients with maxillofacial deformities. The mandibular structure was in relation with the stress within temporomandibular joint (TMJ). However, the current studies on the TMJ stresses in the patients with different maxillofacial deformities are not comprehensive enough. PurposeThe aim of this study was to investigate the compression and morphology of the TMJ in the patients with different maxillofacial deformities under central occlusion. Methods24 patients and 10 asymptomatic individuals were included in this study and divided into patient groups and control group. The 3D models were reconstructed. Muscle forces and boundary conditions corresponding to the central occlusion were applied. Nine morphological parameters of mandible were evaluated. ResultsThe minimum principal stresses in the articular disc and condyle were significantly greater than those of the control group (P<0.05). For the articular disc, the compression on the non-deviation side was greater than those on the deviation side in patients with asymmetrical mandibles. There was difference between both sides in the mandibular prognathism and retrusion groups. The joint space of patients was significantly lower than that of the control group (P<0.05). ConclusionsMaxillofacial deformities might change the condylar position within the articular fossa, which decreased the joint space and increased the compression within TMJ. The patients with asymmetry mandible suffered greater pressure within TMJ on the non-deviation side. The bilaterally over-developed and under-developed mandible in patients might also increase the compression within TMJ.

Retrospective analysis of the treatment of internal disorders of the temporomandibular joint and myofascial pain disorders in the conditions of adult orthodontic reception

BACKGROUND: Internal disorders of the temporomandibular joint (VN TMJ) occur at orthodontic reception no less often than with other types of dental treatment. The main clinical manifestations of VN TMJ are caused by variants of anterior displacement of the articular disc, pathology of the capsular ligamentous apparatus, hypermobility of the mandibular head, and dysfunction of the masticatory muscles. The main symptom of VN TMJ is joint pain (arthralgia) and muscle pain (myalgia). VN TMJ occupies a special place in orthodontic treatment. They can be detected at the initial treatment, and their symptoms can appear at any stage of orthodontic treatment and be a complete surprise for the doctor and the patient, arise after orthodontics, and be associated with it. Since VN TMJ significantly affects the therapeutic process, its outcomes, prognoses, and treatment problems are under the close influence of orthodontists.&#x0D; AIM: To examine the effectiveness of the treatment of VN TMJ and myofascial pain disorders in patients with dental anomalies.&#x0D; MATERIAL AND METHODS: The study retrospectively analyzed case histories of 300 adult patients with dental anomalies in need of orthodontics who underwent examination and treatment in a multidisciplinary dental clinic between 2014 and 2016. The prevalence and structure of VN TMJ were assessed, and myofascial pain disorders (MFDB) and results of their correction were analyzed.&#x0D; RESULTS: A total of 146 (71.5%) patients with myofascial pain and 58 (28.3%) with myofascial facial pain syndrome needed orthodontic treatment more often. In these patients, VN TMJ and maxillary anomalies belonging to class II according to Engle of unilateral distal occlusion, deep bite, and class I with crowding of teeth are more often detected. Internal TMJ disorders with concomitant MFDB in the form of myofascial pain were observed in 168 (82.4%) patients. Myofascial pain disorders without VN TMJ were registered in 36 (17.4%) patients. The overall effectiveness of the treatment of VN TMJ and MFBSD was 46.4% (n=78 patients). No lasting improvement was observed in 35.7% (n=60). Deterioration was registered in 17.8% (n=30). Relapses were noted in 60.7% (n=124). In the treatment of MFDB without VN TMJ, the overall effectiveness of treatment was 5.5% (n=2), stabilization in 50.0% (n=18), and deterioration in 44.4% (n=16).&#x0D; CONCLUSION: Myofascial facial pain is very difficult to treat. In combination with VN, TMJ creates significant and sometimes insurmountable difficulties in adult orthodontics. All this forces specialists to look for new approaches and develop effective ways to optimize orthodontic treatment in the case of TMJ pathology and myofascial pain disorders.

Arthroscopic Posterior Suture Plication in Class V Bronstein Merrill Patients: A Retrospective Study

Comparative data on arthroscopic repair of TMJ with advanced internal derangement is limited. Current research shows a 50 to 63% success rate following arthroscopic surgery in Class V Wilkes and Bronstein Merrill patients.1,2 There is little data comparing arthroscopic techniques when making the clinical decision to perform posterior suture plication of the articular disc as opposed to laser debridement. Typically, Class V Bronstein Merrill patients are poor candidates for suture plication due to disrepair of the articular disc; however, some clinical presentations allow for plication.

The Effect of Disc Displacement on Temporomandibular Joint Morphology in Patients with Disc Displacement

Objective: To examine the morphological properties of temporomandibular joint structures by magnetic resonance imaging (MRI) on patients with and without disc displacement (DD). Methods: Thirty-eight patients with disc displacement and 13 patients without disc displacement were included. Age, gender, and clinical findings such as pain, joint sounds of patients were recorded. The patients were classified as anterior disc displacement with reduction (ADDWR) group, anterior disc displacement without reduction (ADDWoR) group, and control group on MRI. Disc morphology was categorized as biconcave, hemiconvex, biconvex, biplanar, or folded. Condyle morphology was characterized as convex, angled, flat, or rounded. Articular eminence morphology was classified as sigmoid, flattened, box, or deformed. A one-way analysis of variance was used to establish the differences between the values. Results: Biconcave disc and sigmoid articular eminence were the greatest incidence both in ADDWR and control group, folded disc and deformed articular eminence were the most in ADDWoR group. The most frequent types of condyle in DD and control group were flattened and convex, respectively. Statistical difference was found between pain and articular eminence morphology (p=0.02). The statistical difference regarding articular disc (p=0.001) and articular eminence morphology (p=0.02) was determined among the groups. A significant difference between condyle morphology and the presence of self-reported bruxism was detected (p= 0.03). Conclusion: The morphological characteristics of the articular disc and articular eminence are related to DD. It can be said that the morphological changes of temporomandibular joint structures point to DD.

Temporomandibular Joint Conditions in Patients with Craniofacial Microsomia (Literature Review)

Syndromes of I and II gill arches called maxillofacial dysostoses are accompanied by damage of temporomandibular joint (TMJ). Craniofacial microsomia is one of the of maxillofacial dysostoses. This syndrome has a number of features associated with clinical manifestations which should be taken into account at steps of the diagnosis and treatment of such patients. The degree of mandibular hypoplasia in this pathology can vary from 0 to 3, and it is inversely proportional to the integrity of the articular disc on the side of the lesion. An increased mechanical load on a healthy joint leads to its dysfunction and dislocation of the articular disc at the healthy side. In addition to hypoplasia of bone structures, craniofacial microsomia is accompanied by subatrophy of masticatory muscles and that in couple leads to malocclusion and myodynamic imbalance. Before drawing up a treatment plan it is necessary to study the state of the TMJ on both sides using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). The approach to treatment should be individual, combined, staged, based on the severity of the symptom complex.

Added value of dynamic 3T-MRI to conventional static MRI in evaluation of internal derangement of tempromandibular joint

PurposeThis prospective study aimed at comparing dynamic T1W fast field echo sequence to the standard static sequences in the evaluation of TMJ disorders using 3T MRI. Methods8 patients, 14 with bilateral symptomatic internal derangement of TMJ and 4 with unilateral symptoms (32 TMJs) were examined, including 17 females and one male. Static T1W, T2W and PD turbo spin-echo sequences in closed and open mouth positions as well as dynamic T1W-FFE sequence were acquired on 3T MRI unit and images were assessed for the articular disc position, morphological disc changes, condylar morphology and translation. Marginal homogeneity test was used to analyze difference between dynamic and static imaging findings and significant results were considered at p ≤ 0.05. ResultsThe study shows statistically significant difference between static and dynamic MRI in the evaluation of condylar position (p < 0.005). Out of the examined 32 joints, 28 joints (87.5%) had normal condylar position and 4 joints (12.5%) had a subluxated condyle. Dynamic MRI showed 24 joints (75%) had normal condylar position and 8 joints (25%) had a subluxated condyle. Regarding disc morphology and position, dynamic MRI added no significant superior information compared to standard static images. ConclusionStatic MRI of TMJ provides proper accurate assessment of pathological changes in TMJ disorders and considered the gold standard. Dynamic MRI added superior information regarding joint biomechanics even in normal static MRI cases and valuable findings regarding the movement patterns of the condyle and disc in different types of TMJ internal derangement.

Temporomandibular Joint Space Dimensions among Saudi Patients with Temporomandibular Disorders: MRI-Based Retrospective Study.

Introduction The temporomandibular joint is a complex synovial joint in the body. It is the area in which the mandible articulates with the cranium. The temporomandibular joint space is located between the articular eminence and the glenoid fossa of the temporal bone at the base of the skull and the condylar process of the mandible. This interarticular space is divided into superior joint space (1.2 ml) and inferior joint space (0.9 ml) by the articular disc. The purpose of this study is to detect and evaluate the variations in the temporomandibular joint space among patients having temporomandibular joint disorders. Materials and Methods In this retrospective study, 60 magnetic resonance imaging scans were evaluated at King Faisal Specialist Hospital in Riyadh, Saudi Arabia, between the years 2006 and 2016. Measurements were done in sagittal view in three areas: anterior, central, and posterior areas. However, coronal view readings were recorded in two different areas: medial and lateral joint spaces. All measurements were recorded at the highest point of the condyle that is perpendicular to the opposing bone. The SPSS program was used for statistical analysis. Results The central joint space values were higher than the anterior and posterior joint spaces in both coronal and sagittal views. We also found that joint spaces among male patients were higher than female patients (right side P=0.015 and left side P=0.006). It is worth mentioning that the number of temporomandibular joint disorder female patients was more than the number of male temporomandibular joint disorder patients (52 females versus 24 males). Additionally, patients who were older than 55 years old had wider joint spaces than patients who were younger than 25 years old. Conclusion The central joint space value was the highest among the other joint spaces on both views of magnetic resonance imaging, and the values of joint spaces among males were larger than those of females on sagittal magnetic resonance imaging. Patients with elderly temporomandibular joint disorders showed larger joint spaces than young patients. This study spotlights the importance of magnetic resonance imaging evaluation in temporomandibular joint disorder patients for a better understanding of the clinical evolution of temporomandibular disorders.

Advances in Tissue Engineering of the Temporomandibular Joint Disc: An Overview of Current Status and Future Directions.

Advances in tissue engineering have progressed to potentially offer a solution to temporomandibular joint disc (TMJ) disorders not amenable to conservative therapies. Conclusive treatment options for patients with end-stage disc disorders requires discectomy and reconstruction of the articular disc with various materials. Tissue engineering TMJ disc is a promising alternative to the limited and sometimes inadequate clinical options in the management of such disorders. However, tissue engineering is far from completion for the TMJ disc regeneration. This review briefly discusses the properties of native disc, the mechanism by which TMJ disorders manifest, and how a tissue engineered disc could assuage the problems inherent in the management of such disorders. Furthermore, the review addresses and provides updates to relevant themes of tissue engineering in regards to the TMJ disc, namely, the scaffolds, cells and biomarkers, hurdles in tissue engineering of the disc, and its application in translation to the clinical practice and future directions.