Temporomandibular Joint Structures Research Articles

Ultrasonographic study of the temporomandibular joint in individuals with and without temporomandibular disorder.

The present study's aim was to compare temporomandibular joint (TMJ) images for individuals with and without temporomandibular disorder (TMD) using high-resolution ultrasonography (HRUS). The distance between the lateral-most point of the articular capsule and the lateral-most point of the mandibular condyle (lateral capsule-mandibular condyle distance) was determined to confirm the clinical diagnosis according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The sample group comprised 17 women and 15 men, aged 19-39 years, distributed into TMD (n = 20) and Asymptomatic (n = 12) groups. The evaluations were in closed- and open-mouth positions. The lateral capsule-mandibular condyle distance was measured in both positions. The articular surface of the condyle and the articular capsule were visualized as hyperechoic structures, and the articular disk was visualized as a central, hyperechogenic area surrounded by a hypoechoic linear image. Morphological changes were observed in some TMD group participants, including joint effusion (hypoechogenic area), condylar erosions (increased hyperechoic area), and condylar surface irregularities. The lateral capsule-mandibular condyle distance did not differ between sides or groups among participants with intra-articular disorders with or without pain (P > 0.05). In conclusion, HRUS allowed visualization of the TMJ structures, but did not allow confirmation of clinical diagnosis by DC/TMD.

Association between Intra-Articular Corticosteroid Injection and Temporomandibular Joint Structure Changes

Thirty-six female adult Wistar albino rats divided into three groups according to the number of corticosteroid injection, each group has two subgroups according to the time of scarification either after one week or two weeks after the last injection.

Scaffold-Based Temporomandibular Joint Tissue Regeneration in Experimental Animal Models: A Systematic Review.

Reconstruction of degenerated temporomandibular joint (TMJ) structures remains a clinical challenge. Tissue engineering (TE) is a promising alternative to current treatment options, where the TMJ is either left without functional components, or replaced with autogenous, allogeneic, or synthetic grafts. The objective of this systematic review was to answer the focused question: in experimental animal models, does the implantation of biomaterial scaffolds loaded with cells and/or growth factors (GFs) enhance regeneration of the discal or osteochondral TMJ tissues, compared with scaffolds alone, without cells, or GFs? Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines, electronic databases were searched for relevant controlled preclinical in vivo studies. Thirty studies reporting TMJ TE strategies in both small (rodents, rabbits; n = 25) and large animals (dogs, sheep, goats; n = 5) reporting histological and/or radiographic outcomes were included. Twelve studies reported ectopic (subcutaneous) implantation models in rodents, whereas 18 studies reported orthotopic, surgically induced defect models in large animals. On average, studies presented with an unclear-to-high risk of bias. In most studies, mesenchymal stem cells or chondrocytes were used in combination with either natural or synthetic polymer scaffolds, aiming for either TMJ disc or condyle regeneration. In summary, the overall preclinical evidence (ectopic [n = 6] and orthotopic TMJ models [n = 6]) indicate that addition of chondrogenic and/or osteogenic cells to biomaterial scaffolds enhances the potential for TMJ tissue regeneration. Standardization of animal models and quantitative outcome evaluations (biomechanical, biochemical, histomorphometric, and radiographic) in future studies, would allow more reliable comparisons and increase the validity of the results.

CBCT and MRT imaging in patients clinically diagnosed with temporomandibular joint arthralgia

ObjectivesTo compare cone beam computed tomography (CBCT) and magnetic resonance tomography (MRT) in patients with temporomandibular joint (TMJ) arthralgia in respect of the evaluation of bony structures, and to correlate joint space distances measured in CBCT with the morphology and the position of the disc visualized in MRT. Materials & methods26 temporomandibular joints (TMJs) in 13 patients clinically diagnosed with TMJ arthralgia were examined by both CBCT and MRT. All images were evaluated by use of a form. The results were compared in regard of conformability of the diagnoses of osseous structures established by each imaging method. Anterior, superior and posterior joint space distances measured in CBCT-images were related to disc morphology and position visualized in MRT. ResultsConformability of CBCT and MRT in the evaluation of bony TMJ structures ranged from 69.3 to 96.6 %. Osseous alterations such as erosions, osteophytes and cysts detected by CBCT could partly not be discerned by MRT. The correlation of joint space distances with disc morphology (biconcave or not biconcave) was not statistically significant. The correlation of joint space distances and disc position was statistically significant only for the superior joint distance. ConclusionCBCT outclasses MRT in the visualization of osseous alterations, which are diacritic in the differentiation of simple arthralgia from osteoarthritis. Therefore, CBCT imaging is appropriate in patients clinically diagnosed with TMJ arthralgia.Superior joint space distance not being the highest joint space in sagittal CBCT indicates an anterior disc displacement.For the visualization of structural changes or displacement of the disc frequently associated with osseous changes, MRT is the optimal tool. Thus, the combination of the two imaging methods allows a comprehensive diagnosis in TMJ arthralgia patients.

Temporomandibular joint anomalies in pediatric craniofacial Gorham-Stout disease

PurposeGorham-Stout disease (GS) is a rare and little understood bone disease that leads to the progressive replacement of the affected bone by fibrous tissues. The mandible is the most commonly affected craniofacial bone, but there is no report to date of temporomandibular joint (TMJ) lesions in this condition. We aimed to characterize the involvement of the TMJ in this uncommon bone disorder. Material and methodsWe retrospectively included all patients managed for craniofacial forms of GS in our pediatric institution over a period of 12 years. We collected clinical data on TMJ function and radiological data from computed tomography and magnetic resonance imaging. ResultsFour pediatric patients were managed for craniofacial forms of GS between 2005 and 2017. All patients presented with various radiological lesions of the TMJs, including osteolytic lacunae of the condylar head, condylar head flattening and thinning of the glenoid cavity. Only one patient presented with functional TMJ impairment. ConclusionThe TMJ appears to be radiology affected in pediatric craniofacial forms of GS. Nevertheless, TMJ lesions, even when radiologically severe, rarely impair TMJ function. TMJ structure and function should be systematically assessed in craniofacial forms of GS, and, in the case of joint lesions, a regular follow-up of TMJ function should be considered.

Morphological evaluation of temporo-mandibular joint in indian population

The temporomandibular joint (TMJ) is one of the most complex joints in the body and its harmonious functioning is very important to maintain a normal masticatory system. The morphologic alterations and the asymmetrical position of the TMJ structures may lead the various clinicalsigns & symptoms. Morphology of the temporomandibular joint may be influenced by gender of patients, environmental factor and also food habits at various places. Objective: To evaluate the morphology of the temporomandibular joint using computed tomography, in order to determine the condyle shape, joint space and glenoid fossa roof thickness. Material and Methods: One hundred and six healthy patients (212 TMJs) who visited a private hospital (or the University’s Hospital) for CT brain scan were included to this cross-sectional study sample.The patients were aged between 20–50 years with an average age of 35.46 years. All the images were taken by positioning patients in supine position with 120kvp , 50ma,2.33minute exposure with 0.7mm thick slicesby computed topography machine in all three projection that is Axial, Coronal and Saggital view. Results: For all variables, the mean and standard deviation were calculated, based on gender, and TMJ sides. The Paired t-test was used and P<0.05 will be considered to be significant. Conclusion: Present study showed that thereis positive evidence of temporomandibular joint involvement in elderly patients. Change in morphology and position of condylar head with glenoid fossa and roof thickness are one of the most common cause of degenerative diseases.KeywordsTemporomandibular joint; Morphology; Condyle; Joint space.KeywordsTemporomandibular joint; Morphology; Condyle; Joint space

Morphometric analysis for evaluating the relation between incisal guidance angle, occlusal plane angle, and functional temporomandibular joint shape variation

Objective: The correlations between morphology of the temporomandibular joint structure, the anterior guidance angle, and occlusal plane were investigated.Materials and methods: A cone beam computed tomography analysis was performed in 158 patients (86 women and 72 men). 3D software was employed to obtain the coordinates of the shape of the incisal guidance angle, occlusal guidance angle, articular fossa, and mandibular condyle. Generalized Procrustes analysis including principal components analysis (PCA) were performed and produced principal components (PCs) scores of each shape and their centroid size (CS).Results: A significant Pearson correlation coefficient of 0.3451 (p < .001) was observed between the incisal guidance angle and occlusal plane. The CS also showed a correlation with the incisal guidance angle, but not with the occlusal plane angle. The PCA results revealed that there were no significant correlations between the temporomandibular joint structure (TMJ) shape (fossa and condyle) and the incisal guidance angle.Conclusions: Incisor guidance angle and occlusal plane angle were correlated. In addition, there was a correlation between CS and incisal guidance angle. In the PCA, It can be concluded that the size is more related to the incisor guidance angle than the morphological factors of the constituent components of the TMJ.

Patients with chronic pain: degree of kinesiophobia related to dance practice

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder is a generic term for conditions that affect the temporomandibular joint, mastication muscles and/or associated structures. The multifactor etiology of the temporomandibular disorder requires multidisciplinary treatment. As constant pain is one of the main characteristics of this disorder, some patients limit their movements during physical activities as a defense mechanism to protect against pain. The present study aimed to determine whether the participation of individuals with the temporomandibular disorder in dance therapy is related to the fear of practicing physical activities. METHODS: An exploratory, quantitative study was conducted with a sample of 35 patients with chronic pain recruited from a clinic specialized in the diagnosis and treatment of temporomandibular disorder. The participants were allocated to two groups: active group (n=14) and control group (n=21). The Brazilian version of the Tampa Scale for Kinesiophobia was used to measure the fear of movement. RESULTS: Mean age was 46.4 years in the active group and 42.9 years in the control group. The mean kinesiophobia score (on a scale of 17 to 68) was 39 in the active group and 39.8 in the control group. CONCLUSION: The present findings demonstrate no significant difference in terms of the degree of kinesiophobia between individuals who agreed and declined to participate in the proposed activity (dance).

Biomechanical effects of a mandibular advancement device on the temporomandibular joint

PurposeMandibular advancement devices are commonly used in the treatment of patients with mild to moderate obstructive sleep apnea (OSA). Designed to maintain the mandible in forced protrusion while being worn, mandibular advancement devices (MADs) are intended to increase the upper airway during sleep, thereby reducing OSA symptoms. Depending on the extent of mandibular protrusion, side effects including temporomandibular joint dysfunction are frequently reported. These are likely to reduce overall treatment success by affecting therapeutic adherence. Material and methodsTo investigate the biomechanical effects of an MAD on the temporomandibular joints, we used a biomechanical model of the human masticatory system. Alterations to the model were applied to mimic the effects of a titratable duoblock MAD. The extent of mandibular protrusion was simulated up to 10 mm in steps of 1 mm. Compression and shear stresses on the temporomandibular structures were predicted during an open–close maneuver and in neutral position. ResultsAs the extent of mandibular advancement increased, the mandibular condyle migrated anteriorly until passing the articular tubercle. Stress on the temporomandibular joint structures did not considerably increase in rest whatever the extent of mandibular advancement. However, closure of the jaw required extra muscle force as mandibular advancement increased. ConclusionResults from this study suggest that temporomandibular dysfunction following MAD wearing might be related to altered muscle dynamics rather than changes due to increased stress in the temporomandibular joint itself.

Temporomandibular joint using the Bite Turbos appliance. It´s important to realize a case - control trial that evaluated those possible effects.

The purpose of this review is identify the possible diagnostics methods of the Temporomandibular Joint that can determine the behavior of itself when oclusal changes occur. In addition, the secondary objective are know relevant information about occlusion, Temporomandibular Joint (TMJ), bite turbos and contemporaneous diagnostics methods for the TMJ and near structures. A literature reviewed with a total background of 44 articles. Those articles include concepts of functional occlusion, Temporomandibular joint development and the importance on the patient’s occlusion pattern, also the Bite Turbos as an important mechanism to help the orthodontic treatment, and finally the reports that supports diagnostics methods to evaluate de Temporomandibular complex like the Cone-Beam Computer Tomography as a vanguard method. We concluded that the Cone Beam CT was an excellent method to evaluate the Temporomandibular complex, and has a great relationship between riskbenefits. In addition, we conclude that there were insufficient information about the possible effects on the Temporomandibular joint using the Bite Turbos appliance. It´s important to realize a case control trial that evaluated those possible effects.&#x0D; Key words: Orthodontics, disarticulation, cone-beam computed tomography, temporomandibular joint, dental occlusion.

The IL-1Ra gene variable number tandem repeat variant is associated with susceptibility to temporomandibular disorders in Turkish population.

Temporomandibular joint disorders (TMD) are a group of disorders involving temporomandibular joint and related structures. Interleukine-1 receptor antagonist (IL-1Ra) is an important anti-inflammatory molecule that competes with other interleukin-1 molecules. This study was designed to investigate the possible association of the IL-1Ra VNTR variant with the risk of TMD in the Turkish population. Peripheral blood samples were collected from 100 patients with TMD (23 males, 77 females) and 110 healthy individuals (35 males, 75 females). Genotyping of IL-1Ra 86bp VNTR variant was evaluated by gel electrophoresis after polymerase chain reaction (PCR). Our results show that there is a statistically significant difference between TMD patients and control group with respect to IL-1Ra genotype distribution and allele frequencies. 1.2, 1.4, and 4.4 genotypes were more common in patients, while 2.2 and 3.3 genotypes were rarer (P<.000). Frequency of alleles 1 and 4 was higher in patient groups (P<.000), whereas alleles 2 and 3 had a lower frequency in patients with TMD (P<.000). This is the first correlation study that evaluates the association between IL-1Ra gene VNTR variant and TMD. The VNTR variant related to IL-1Ra gene showed a strong pattern of association with TMD that may have a potential impact on disease counseling and management. Larger studies with various ethnicities are needed to establish the impact of IL-1Ra VNTR variant on risk of developing TMD.

3D Morphology Analysis of TMJ Articular Eminence in Magnetic Resonance Imaging.

Purpose The objective of this study was to evaluate the computational reconstruction of the articular eminence of the temporomandibular joint (TMJ) based on magnetic resonance imaging (MRI) and semiautomatic volumetric segmentation techniques for morphological classification of the TMJ structure. Materials and Methods A total of 36 MRI scans of TMJ individuals were selected and formatted by using the ITK-SNAP software, consisting of MRI segmentation and generation of 3D models. The TMJ articular eminences were also classified according to the morphology analysis of the articular eminence in 3D reconstructions. Two independent trained and calibrated investigators performed the image analysis, which was repeated after thirty days. Results There was no association between sex and eminence shape (p = 0.456). Fisher's test revealed no statistically significant association between disc classification and eminence shape on both sides (p = 0.629). Chi-square test showed a significant statistically association between disc classification and disc displacement (p = 0.000). Intra- and interrater correlation coefficients showed excellent reproducibility values. Conclusions Anatomical variability of the sample investigated was found, with predominantly round shape and presence of correlation between this shape and normal disc position. The correlation of flattened and convex shapes with disc position reduction indicated that type of disc derangement is more prevalent.

Efficacy of splint therapy for the management of temporomandibular disorders: a meta-analysis.

Temporomandibular disorders (TMD) are a group of clinical problems affecting temporomandibular joint (TMJ), myofascial muscles and other related structures. Splint therapy is the most commonly used approach to treatment of TMD, but its effectiveness is remains unclear. We therefore conducted a meta-analysis to evaluate the effectiveness of splint therapy for TMD in adults. The electronic databases PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched for reports published up to March 31, 2016. Thirteen eligible studies involving 538 patients were identified. The results indicated that splint therapy increased maximal mouth opening (MMO) for patients with a MMO <45mm and reduced pain intensity measured using the visual analogue scale (VAS) for patients with TMD without specific description (TMDSD). Splint therapy also reduced the frequency of painful episodes for patients with TMJ clicking. No publication bias was observed, as determined with Egger's test for all outcomes. On the basis of this evidence, we recommend the use of splints for the treatment and control of TMD in adults.

Comparison of volume and position of the temporomandibular joint structures in patients with mandibular asymmetry

To evaluate the volume and position of the temporomandibular joint structures, specifically the glenoid fossa and the condylar head, in patients with facial asymmetry. Fifty-six adult patients were divided into two groups-asymmetry group and control group-based on the severity of the mandibular asymmetry, as seen on their orthopantomograms. The volumes and positions of the bilateral temporomandibular joint components were measured by using computed tomography images and a three-dimensional analysis program. Each of the variables was compared between and within the groups. The volumes of the condyle and the glenoid fossa on the side of the smaller condyle were significantly smaller in the asymmetry group (P<.05) than in the control group. The volumetric ratios of the glenoid fossa and the joint space to the condyle were also significantly higher on that side (P<.001). The distance of the uppermost point of the glenoid fossa from themidaxial plane in the smaller condyle was significantly shorter (P<.05) only in the asymmetry group. When evaluating mandibular asymmetry, the volume of the glenoid fossa and the volume and vertical position of the condylar head need to be considered in addition to length or width of the condylar head.

Juvenile porcine temporomandibular joint: Three different cartilaginous structures?

ObjectiveThe temporomandibular joint (TMJ) consists of three cartilaginous structures: the fossa, disc, and condyle. In juvenile idiopathic arthritis (JIA), inflammation of the TMJ leads to destruction of the condyle, but not of the fossa or the disc. Such a different effect of inflammation might be related to differences in matrix composition of the cartilaginous structures. MethodsThe matrix composition of the three TMJ structures was analyzed in juvenile porcine samples and in an in vitro system of cells isolated from each anatomical structure embedded in 3% agarose gels. ResultsThe matrix of all three anatomical structures of the TMJ contained collagen type I and its gene expression was maintained after isolation. The condyle and the fossa stained positive for collagen type II and proteoglycans, but the condyle contained considerably more collagen type II and proteoglycans than the fossa. The disc contained neither collagen type II protein nor expression of its gene, and the disc did not stain positive for proteoglycans. Aggrecan gene expression was lower in the disc compared to condyle and fossa cell-isolates. In general, the cell-isolates in vitro closely mimicked the characteristic features found in the tissue. ConclusionThe collagen type II content of the condyle clearly distinguished this cartilaginous structure from the disc and fossa. Since autoimmunity against collagen type II is associated with JIA, the relatively abundant presence of this type of collagen in the condyle might provide an explanation why primarily this cartilaginous structure of the TMJ is affected in JIA patients.

PECULIARITIES OF THE STRUCTURE OF THE TEMPOROMANDIBULAR JOINT IN INDIVIDUALS WITH DIFFERENT DIRECTION OF GROWTH OF THE FACIAL PART OF THE SKULL

The characteristics of the structure of the temporomandibular joint (TMJ) in individuals with different direction of growth of the facial part of the skull were studied. Cone beam computed tomography data were analyzed in 16 young (mean age 29±7 years) orthodontic patients (32 joints) before treatment, which had class II dentition ratio. The patients were divided into 2 groups (4 men and 4 women in each): with strongly expressed vertical and horizontal types of facial growth. In patients with a vertical type of facial growth, the reduction of the size of joint spaces was noted in anterior, posterior, upper, oral and buccal parts of TMJ. In patients with a vertical type of facial growth anterior articular angle was smaller than in those with a horizontal growth type. The data obtained indicate the relationship of the structure of TMJ and the direction of growth of the facial part of the skull.

Ультразвуковая визуализация височно-нижнечелюстного сустава в норме

&lt;p class="p1"&gt;&lt;span class="s1"&gt;Modern publications on the ultrasound anatomy of the temporomandibular joint (TMJ) contain contradictory data as to the assessment of the intra-articular disk, the morphological characteristics of the joint structures imaging. The article describes the ultrasound visualization of the temporomandibular joint in health on the basis of longitudinal and transverse methods of research. The prospective study involved 12 patients (3 men, 9 women; average age – 25,4±2,7 years). Clinical and ultrasound examination of the TMJ on the Visor 11 HD machine (Philips, USA) was conducted. Using longitudinal and transverse methods of scanning provides good visualization of the soft tissue structures of the TMJ. The capsule is de ned as an unceasing, homogeneous hypoechoic linear structure of 0,4±0,05 mm. the Width of the capsule-cervical space amounted to an the average of 1,1±0,05 mm. The joint space is clearly seen as a hypoechoic space above the surface of the lower jaw head. The disk, the bilaminar area of the TMJ on the echogram are not visualized clearly, and therefore the estimation of their sizes, shapes, and structures is dif cult. The lateral pterygoid muscle is determined on the echogram as a soft-tissue hypoechoic structure with a longitudinal direction of the muscle bers. The head of the mandible is traced in a limited area, has a semi-oval shape and a sharp, even contour. The obtained characteristics of the descriptive and morphometric diagnostics of TMJ structures are compared with the previously published data. &lt;/span&gt;&lt;/p&gt;

Characteristics of temporomandibular joint structures after mandibular condyle fractures revealed by magnetic resonance imaging.

BackgroundThis study aimed to evaluate the structural changes of temporomandibular joint immediately after condylar fractures with magnetic resonance imaging (MRI).MethodWe evaluated 34 subjects of condylar fractures with MRI. The position, shape, and signal intensity of the condyle, disc, and retrodiscal tissue were analyzed with MR images.ResultsImmediately after trauma, the disc was displaced with the fractured segment in almost all cases. And, the changes of signal intensity at the retrodiscal tissue were found but less related to the degree of fracture displacement. And, the high signals were observed almost at all fractured joint spaces and even at some contralateral joints.ConclusionsThe displaced disc as well as the increased signal intensity of the joint space, condylar head, and retrodiscal tissue demands more attention to prevent the possible sequela of joint.

Imaging analysis of temporomandibular joint anatomy changes after intraoral condylectomy combined with orthognathic surgery

To quantitatively analyze the changes of facial symmetry and temporomandibular joint structure at different periods after intraoral condylectomy combined with orthognathic surgery, and to evaluate the long-term stability after the operation. Spiral CT data of 10 cases treated by intraoral condylectomy combined with orthognathic surgery were collected, and then reconstructed by ProPlan software. Mark points were drawn on the 3D-images reconstructed immediately after the operation, and 6 months and 12 months after the operation. The measurements parameters included condylar axis angle in three dimensions, condylar-glenoid relative position and condylar facial morphology related indicators. The results were statistically analyzed by the consistency test and the variance of repeated measurement data. The facial asymmetry of the patients was corrected after operation, the height of the affected mandibular ascending ramus(T1: [67.81±6.95]mm, T2: [64.49±6.24]mm, T3: [63.05±7.07]mm)as well as the degree of pogonion deviation decreased(T1: [2.79±4.93]mm, T2: [0.37±4.20]mm, T3: [0.33 ± 3.97]mm)(P<0.05). But the tilt angle of the occlusion plane and the degree of mandibular height asymmetry had no significant difference between all the post-operative periods(P>0.05). The post-operative 3D changes of the position and shape of the resected and its contralateral condylar showed that the bilateral condylar axis angle in the horizontal plane gradually grew after operation(affected condyle: 71.95° ± 7.47°, 74.73°±8.44°, 76.56°±5.22°; control condyle: 72.60°±5.56°, 76.00°±5.30°, 77.19°±6.20° and had significant difference between all the post-operative periods)(P<0.05), the condyle moved slowly upward on both sides(superior space on the affected side: [8.78±4.38]mm, [4.11±2.49]mm, [3.27±1.96]mm; on the control side: [3.63±1.49]mm, [2.52±1.19]mm, [2.38±1.11]mm)(P<0.05), and moved inward only on the affected side(P< 0.05). All the above changes slowed down over time, and the disc-condyle-fossa relative position tended to be stable over time as well. The condyle diameter on the inside-outside direction gradually decreased on the affected side(T1: [14.98±2.39]mm, T2: [14.04±2.68]mm, T3: [13.74±2.89]mm)(P<0.05), and the surface morphology of the resected condyle was similar to the normal side. There were also some condylar surface morphological changes on the control side, but no statistical significance was found between different periods after the peration(P>0.05). The intraoral condylectomy combined with orthognathic surgery can eliminate condylar lesions effectively and correct the facial asymmetry caused by condylar benign tumor and hyperplasia. The facial symmetry can be maintained well after the operation, and the post-operative condylar morphology changes tended to be stable six months after the operation.

Analysis of cone beam CT for the skeletal structure of temporomandibular joint in patients with sleep bruxism

Analysis of cone beam CT for the skeletal structure of temporomandibular joint in patients with sleep bruxism