Treatment Of Temporomandibular Joint Osteoarthritis Research Articles

THE EFFECT OF SINGLE VERSUS MULTIPLE INTRA-ARTICULAR INJECTION OF SYNOVIAL FLUID MESENCHYMAL STEM CELLS ON RAT TEMPOROMANDIBULAR JOINT WITH INDUCED ARTHRITIS. BIOCHEMICAL AND HISTOLOGIC ANALYSIS

Introduction: Osteoarthritis (OA) is the most common chronic musculoskeletal disorder. Nowadays, the role of synovial fluid mesenchymal stem cells (SF MSCs) is increasingly attributed to the treatment of Temporomandibular joint osteoarthritis. This study aimed to compare single versus multiple intra-articular injection of SFMSCs in terms of macroscopic, biochemical, and histological analysis. Material & methods: 18 young adult male 200–300 grams albino rats were used in the current study divided randomly into 3 equal groups. Group (A) comprised control in which OA was induced with no treatment, group (B) comprised MSCs single intra-articular injection group, and group (C) comprised MSCs multiple intra-articular injection group. Biochemical and histologic analysis were performed. Results: histological findings showed that both groups B, C showed regeneration of meniscus and retrodiscal tissues, but group C was superior in regeneration compared to group B. Biochemical analysis showed that TNF-α and IL-1B had the highest value in the control group, followed by the single injection group, while the lowest value was found in multiple injections group respectively. Conclusion: Multiple Intra-articular SF MSCs is a potential disease-modifying therapy for patients suffering from TMJ-OA.

Non-invasive approach in the treatment of temporomandibular joint osteoarthritis

Introduction. Temporomandibular dysfunction (TMD) is a set of disorders that involve the masticatory muscles, the temporomandibular joint (TMJ), and its associated structures. Osteoarthritis (OA), as one of the forms of TMD, leads to permanent changes in the bone structures of TMJ. These changes can be the cause of serious functional disorders of the TMJ. Case outline. This article describes a case of a 24-year-old female patient who sought help due to pain and swelling in the area of the right and left TMJ, accompanied by muscular tension, severe headaches, which did not respond to medication. ?fter establishing the diagnosis, we applied a therapy in the treatment of the bilateral OA of the TMJ, where we used non-invasive methods. Six months later, the patient reported the absence of pain, swelling, headache, and muscle tension in the orofacial region. Conclusion. There is no ?gold standard? for the management of ?? of ???. In our study, non-invasive therapy was successful in eliminating pain, increasing the range of motion of the lower jaw, stopping the progression of the disease, and advancing the quality of life.

Comparison of Autologous Platelet-Rich Plasma and Chitosan in the Treatment of Temporomandibular Joint Osteoarthritis: A Retrospective Cohort Study

The purpose of this article is to study the effect of autologous platelet-rich plasma (PRP) injected into the upper cavity of the temporomandibular joint (TMJ) on the treatment of TMJ osteoarthritis. We retrospectively analyzed the data of 27 patients with TMJ osteoarthritis treated at the China Medical University Hospital of Stomatology from September 2018 to September 2019. Maximal interincisal opening, pain intensity, and TMJ sounds were recorded and compared before treatment and at the 3rd and 6th months after the treatment. SPSS 24.0 software was used to analyze the data of each group, and the imaging changes in the condylar bone were compared before and 6months after the treatment. The P-value was set at .05. Better results were observed in the group treated with PRP on maximal interincisal opening and pain intensity than in the group receiving chitosan treatment. Regarding TMJ sounds, relief was observed in both groups, with no significant difference. The effect of PRP on the improvement of the maximal interincisal opening and pain intensity of patients with TMJ osteoarthritis is better than that of chitosan. However, it should be noted that the incidence of complications associated with the injection of PRP may be higher than that with injection of chitosan.

Platelet Concentrate Treatments for Temporomandibular Disorders: A Systematic Review and Meta-analysis.

This systematic review compared platelet concentrates (PCs) versus hyaluronic acid (HA) or saline/Ringer's solution injections as treatments of temporomandibular osteoarthritis and disc displacement in terms of pain and maximum mouth opening (MMO). PubMed, Cochrane, and Scopus were searched up to March 6, 2020. Inclusion criteria were randomized clinical trials (RCTs). Exclusion criteria were case series, observational studies, animal studies, and reviews. The Effective Public Health Practice Project (EPHPP) quality assessment tool was used to assess the risk of bias in the included studies. The weighted mean difference was used to compare the results. Nine RCTs were included with a total of 407 patients. The numbers of joints treated were 262, 112, and 112 in the PC, HA, and saline groups, respectively. The quality of studies was rated as strong in 4 studies, moderate in 4 studies, and weak in 1 study. The meta-analysis revealed that PCs decreased pain visual analogue scale (VAS) scores compared to HA by an average of -1.11 (CI, -1.62 to -0.60; P < 0.0001) and -0.57 (CI, -1.55 to 0.41; P = 0.26) at 3 and 12 mo follow-up respectively. Also, the average decrease in pain scores with PC compared to saline was -1.33 (CI, -2.61 to -0.06; P = 0.04), -2.07 (CI, -3.46 to -0.69; P = 0.003), and -2.71 (CI, -4.69 to -0.72; P = 0.008) at 3, 6, and 12 mo, respectively. Regarding MMO measurements, PC was comparable to HA, but it was significantly better than saline after 3 and 6 mo [2.9 mm (CI,1.47 to 4.3; P < 0.0001), and 1.69 mm (CI, 0.13 to 3.25; P = 0.03) respectively]. PC reduces pain VAS scores compared to HA during the first 3 m after treatment, and when compared to saline, it reduces pain and increases MMO for longer durations. However, due to differences between groups regarding PC preparation protocols and study heterogeneity, further standardized RCTs are required. This study provides researchers and clinicians with quantitative and qualitative analyses of the current evidence regarding the clinical outcomes of platelet concentrate injections in the treatment of temporomandibular joint osteoarthritis and disc displacement in terms of pain control and maximum mouth opening.

Knockdown of long non‑coding RNA AK094629 attenuates the interleukin‑1β induced expression of interleukin‑6 in synovium‑derived mesenchymal stem cells from the temporomandibular joint.

Interleukin (IL)-1β is a key promotor in the pathogenesis of temporomandibular joint osteoarthritis. Differentiation of stem cells to cartilage is a crucial repair mechanism of articular cartilage damage, and IL-1β has been reported to impede the differentiation by upregulating the secretion of IL-6, an important inflammatory factor. Long non-coding RNAs (lncRNAs) regulate a number of physiological and pathological processes, but whether lncRNA AK094629 contributes to the IL-1β mediated induction of inflammation remains unclear. Therefore, the aim of the present study was to investigate the effect of AK094629 on IL-1β-induced IL-6 expression in synovial-derived mesenchymal stem cells (SMSCs) of the temporomandibular joints. The results of the present study demonstrated that the expression of AK094629 in the synovial tissue of patients with osteoarthritis was positively correlated with IL-1β. In addition, IL-1β upregulated the expression of AK094629 in the SMSCs in vitro, and AK094629 knockdown inhibited the IL-1β mediated upregulation of IL-6. The present study also demonstrated that AK094629 knockdown downregulated the expression of the mitogen-activated protein kinase kinase kinase 4 (MAP3K4), which is upregulated by IL-1β, whereas knockdown of MAP3K4 did not affect the expression of AK094629, but reversed the upregulation of IL-6 in SMSCs. In conclusion, AK094629 knockdown attenuated the expression of IL-1β-regulated IL-6 in the SMSCs of the temporomandibular joint by inhibiting MAP3K4. Therefore, AK094629 may be a potential novel therapeutic target for the treatment of temporomandibular joint osteoarthritis.

Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature.

Background and objectives: There is an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.

Evaluation of the therapeutic potentials of adipose Derived stem cells in comparison to hyaluronic acid in temporomandibular joint osteoarthritis A multi assessment study

Objective: This study aims to assess the effectiveness of arthrocentesis followed by intraarticular injection of adipose derived stem cells versus hyaluronic acid in treatment of temporomandibular joint osteoarthritis and reversing the ongoing degenerative cascade. Evaluation was based on clinical radiographic and biochemical findings.Materials and Methods: The study included thirty patients suffering from TMJ/OA. Clinical criteria and Computerized Tomography (CT scan) confirmed the diagnosis. Patients were divided into two equal groups; both groups underwent arthrocentesis pursued by hyaluronic acid injection for Group I, and chondrogenic differentiated adipose derived stem cells for Group II. Synovial fluid samples were collected preoperative and at the end of the study (18 months) to assess the TGFβ1 concentration. Clinical data (maximal mouth opening, lateral, protrusive movements, pain and joint sounds) were collected at 3, 6, 12 and 18 months. CT scans were repeated at 18 months.Results: Group I showed initial improvement within clinical parameters but failed to sustain these results till the end of the study, no marked radiographic changes were noted. However, the TGF β1concentration showed significant decrease. Group II showed significant improvement within all parameters, Radiographic findings manifested remodeling of degenerative findings and TGFβ1 concentration was significantly decreased.Conclusion: Adipose derived stem cell is an effective therapeutic treatment for TMJ/OA. It subsided all related clinical dysfunction and abates the ongoing degenerative cycle.

Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis.

This study evaluated the long-term effectiveness of intra-articular temporomandibular joint arthrocentesis for patients with osteoarthritis and compared arthrocentesis/lavage alone with arthrocentesis/lavage and injected hyaluronic acid. Forty patients met the inclusion criteria, and 37 completed long-term follow-up (approximately 4 years). The patients were randomly allocated to two groups: arthrocentesis with lavage alone (A-group, n = 17) or combined with hyaluronic acid treatment (AS-group, n = 20). Standard two-needle arthrocentesis was performed. Pain and joint sounds were measured at baseline and approximately 4 years after treatment. Reported pain, as indicated by visual analogue scale (VAS) score, significantly decreased from baseline to the final follow-up examination in both groups. Mean VAS score decreased from 64 to 16 (P < 0.001) in the A-group and from 63 to 25 (P < 0.001) in the AS-group. Average maximum incisor opening increased significantly in both groups but did not significantly differ between groups (P = 0.223). Joint sounds did not significantly improve within groups (A-group, P = 0.495; AS-group, P = 0.236). Both methods resulted in significant long-term improvements in pain and jaw function.

Role of neuropeptide substance P and the bone morphogenetic protein signaling pathway in osteogenic differentiation of ST2 cells

This study aimed to investigate the role and mechanism of neuropeptide substance P (SP) in ST2 cell (bone mesenchymal stem cells of mice) osteogenic differentiation to provide a basis for the treatment of temporomandibular joint osteoarthritis. Third-generation ST2 cells were cultured with different concentrations of SP (0, 10⁻¹⁰, 10⁻⁸, 10⁻⁶, and 10⁻⁵ mol·L⁻¹). After 24, 48, and 72 h, cell proliferation was detected by CCK-8. The ST2 cells were cultured with 10⁻⁶ mol·L⁻¹ SP for 1, 3, 5, and 7 days. Subsequently, the expression of alkaline phosphatase (ALP), collagen typeⅠ(CollaⅠ), and osteocalcin (OCN) in the culture supernatant was tested by enzyme-linked immunosorbent assay (ELISA). ALP activity was detected by immunofluorescence staining. The ST2 cells were cultured with SP, Noggin (inhibitor of the bone morphogenetic protein signaling pathway), SP+Noggin, and 2% fetal bovine serum, respectively. Finally, the expression of ALP, CollaⅠ, and OCN in the culture supernatant was tested by ELISA. CCK-8 showed that the effect of cell proliferation was most obvious when the SP concentration was 10⁻⁶ mol·L⁻¹ (P<0.01). The ELISA results demonstrated that ALP expression significantly increased at day 5 compared with that in the control group (P<0.01), whereas the expression of CollaⅠand OCN significantly increased at day 7 (P<0.05). Immunofluorescence results showed that ALP activity was strongest at day 5. The expression of ALP, CollaⅠ, and OCN decreased after Noggin addition (P<0.05). SP can promote the proliferation and osteogenic differentiation of ST2 cells, and the bone morphogenetic protein signaling pathway may be involved in this process.

RNA sequencing reveals target genes of temporomandibular joint osteoarthritis in rats after the treatment of low-intensity pulsed ultrasound

PurposeTo explore the potential molecular mechanism of low-intensity pulsed ultrasound (LIPUS) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA), and identify the target genes for therapy of TMJ-OA. MethodsRat TMJ-OA was induced by unilateral occlusal trauma (UOT). At 8 weeks, the experimental group rats were treated by LIPUS for 4 weeks (5 days every week). The cartilage was examined by histological techniques. Gene expression profile in control, placebo and LIPUS-treated group were measured by RNA sequencing (RNA-Seq). Gene oncology (GO) and kyoto encyclopedia of genes and genomes (KEGG) annotated were performed and ten differentially expressed genes (DEGs) were further validated in another individual by quantitative real-time polymerase chain reaction (qRT-PCR). Per-2, a circadian rhythm gene, was further confirmed by western blot. ResultsTMJ-OA model was successfully established in rats through UOT. LIPUS played a positive role in attenuating the retrogression of cartilage. The cartilage lesion was determined by HE and Safranin-O staining. A significant and bran-new gene profile of 58 mRNAs was obtained from the RNA-Seq (LIPUS-treated/placebo) and generated approximately 30GB data. Annotation, functional classification and pathway of the data were analyzed based on GO and KEGG database and ten candidate DEGs were identified. Some of these genes were proved to be related to OA, such as matrix-degrading enzyme (ADAMTS-8), complement (C1qa, C3, C5aR1). Some were reported for the first time in TMJ-OA, such as circadian gene (Per-2, Dbp, Npas2 and Arntl). According to the results of qRT-PCR validation, the sequencing data was with a high degree of credibility. The circadian gene Per-2 was up-regulated by LIPUS in TMJ-OA on the mRNA and protein level. ConclusionThis study reveals the potential therapeutic genes related to TMJ-OA. Especially the circadian Per-2 gene was detected up-regulated by the treatment of LIPUS. It provides us a precious, new target OA-related gene and further investigation of gene-function will provide us new insights in understanding the potential mechanical underling TMJ-OA.

Potential Role of Rebamipide in Osteoclast Differentiation and Mandibular Condylar Cartilage Homeostasis

Background: Temporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease that involves changes in subchondral bone and progressive degradation of cartilage. Currently, rebamipide, a gastroprotective drug, is administered to protect gastric mucosa and accelerate ulcer healing.Objectives: Recent studies have shown that rebamipide also attenuates cartilage degeneration by suppressing oxidative damage and inducing homeostasis of the extracellular matrix of articular chondrocytes. Regarding the latter, reduced expression of cathepsin K, NFATc1, c-Src, and integrin β3, and increased expression of nuclear factor-kappa B, have been found to be mediated by the transcription factor, receptor activator of nuclear factor kappa-B ligand (RANKL).Methods: Treatment with rebamipide was also found to activate, mitogen-activated protein kinases such as p38, ERK, and JNK to reduce osteoclast differentiation. Taken together, these results strongly indicate that rebamipide mediates inhibitory effects on cartilage degradation and osteoclastogenesis in TMJ-OA.Results and Conclusion: Here, we highlight recent evidence regarding the potential for rebamipide to affect osteoclast differentiation and TMJ-OA pathogenesis. We also discuss the potential role of rebamipide to serve as a new strategy for the treatment of TMJ-OA.

A comparative study for the efficiency of the Platelet-rich plasma and hyaluronic acid in treatment of temporomandibular joint osteoarthritis

Objectives: The aim of this study is to compare the effect of Platelet-rich plasma (PRP) and Hyaluronic acid (HA) in management of Temporomandibular joint osteoarthritis (TMJ-OA) Patients and methods: Among 46 patients who were diagnosed with TMJ-OA, 14 patients were treated with PRP, 17 patients were treated with HA and 15 patients were treated with arthrocentesis alone, evaluation of clinical improvement was done for each patient postoperatively at 6 and 12 months.Results: After 6 months, there were no statistically significant differences in the mean changes between PRP and HA groups regarding the pain intensity value, joint sound and extent of maximum mouth opening, while at the end of the follow-up period, after 12 months, better clinical results were maintained in the group treated with PRP.Conclusion: The application of PRP is more effective and remains for long term than HA injection TMJ-OA treatment.

Effect of Concentrated Growth Factors on the Repair of the Goat Temporomandibular Joint

To explore the potential use of concentrated growth factor (CGF) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA). Surgical defects were created bilaterally on the condylar cartilage and bone to induce TMJ-OA in goats. CGF was applied to the right joints (CGF group) and physiologic saline was applied to the left joints (unrepaired group). There was a 1-month period of observation after the operation. These joint specimens were evaluated and compared based on gross appearance and histopathologic observations with hematoxylin and eosin (HE). The histopathologic scores of the condylar cartilage and repaired tissue, including cartilage, bone, and connective tissues, were compared between the 2 groups using SPSS 17.0 software. The unrepaired condylar surface was uneven, whereas the CGF-repaired condylar surface appeared smoother and was covered by cartilage-like tissue. HE staining of the unrepaired condyle showed exposed subchondral bone covered with rare connective tissue and an inflammatory reaction, whereas the CGF-repaired condyle showed tissue repair and regeneration, with bone regeneration and cartilage and a covering of connective tissue over the operated surface. The histologic score of the CGF group was significantly lower than that of the unrepaired group (P= .0127). The CGF group exhibited a significantly larger area of new cartilage and bone generation than the unrepaired group (P= .008 and P= .002, respectively). CGF might play an important role in processes of the molecular response to TMJ-OA. It can mediate inflammation, protect the subchondral bone, assist cell proliferation, and induce tissue repair in TMJ-OA.

The role of TGF-ß1 in osteoarthritis of the temporomandibular joint in two genetic mouse models

ObjectiveThe objective of this study is to elucidate osteoarthritis (OA) progression in the temporomandibular joint (TMJ) in two genetic mouse models by assessing the expression of an identified inflammatory marker associated with OA, viz., Tgf-ß1. This study provides mechanistic insight into disease progression based on the temporal expression of Tgf-ß1 in the TMJ. DesignThe two models included the heterozygous chondrodysplasia mutation (cho/+), a Coll11a1 mutation, and the autosomal semidominant disproportionate micromelia mutation (Dmm/+), a Col2a1 mutation. To determine OA status histologically, TMJs from each mutant were fixed, sectioned and stained with Safranin O to identify proteoglycans in condylar cartilage and counterstained with Fast Green. The extent of staining and onset of OA-like changes were quantified using the Modified Mankin scoring system. Using immunofluorescence, selected tissue sections of each genotype were stained for the presence of Tgf-ß1, HtrA1, and p-Smad2. ResultsThe results revealed Mankin scores of the condylar cartilage of both mutants that are consistent with established histopathological changes of OA. Immunofluorescence indicated increased expression of all three molecular markers and their co-localization within condylar chondrocytes of both mutants. ConclusionsElevated Tgf-ß1 expression in mutant condylar cartilage supports the hypothesis that this inflammatory mediator is mechanistically involved in the pathogenesis of TMJ OA. Compared to basal expression in control TMJs, the positive co-localized staining for Tgf-ß1, HtrA1, and p-Smad2 in both mutants demonstrates involvement of these molecules in the degradative pathway of OA. Tgf-ß1 therefore is a potential target for further study for the diagnosis and treatment of TMJ OA.

Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial

To compare the long-term clinical and radiologic outcomes of temporomandibular joint osteoarthritis (TMJ-OA) treated with arthrocentesis plus platelet-rich plasma (PRP) versus arthrocentesis alone. A randomized clinical trial in adult patients with TMJ-OA referred to the authors' clinic from May 2012 through July 2013 was implemented. The sample was composed of 30 consecutive patients with TMJ-OA treated randomly with arthrocentesis alone (control group) or initial arthrocentesis plus PRP injection and then 4 consecutive PRP injections (study group). The predictor variable was treatment technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, joint sounds, and pain complaints), maximal interincisal opening, and cone-beam computed tomographic (CBCT) findings. Outcome variables were recorded preoperatively and 12 months postoperatively. Descriptive and bivariate statistics were computed, and significance was set at a P value less than .05. The paired t and Student t tests were used for intragroup and intergroup comparisons, respectively. The sample was composed of 47 joints of 30 patients with OA (control group: 15 joints of 12 patients; mean age, 35.08 ± 14.84 yr; study group: 32 joints of 18 patients; mean age, 32.22 ± 14.32 yr). Joint sounds and general pain complaints decreased statistically in the 2 groups, whereas masticatory efficiency, painless interincisal opening, and lateral motion increased statistically only in the study group. However, only masticatory efficiency showed statistically greater improvement in the study group compared with the control group. CBCT evaluations showed that reparative remodeling of the osseous abnormalities occurred at rates of 87.5 and 46.6% in the study and control groups, respectively. These findings suggested that arthrocentesis and PRP injections constitute a safe and promising method for the treatment of TMJ-OA that is superior to arthrocentesis alone.

Treatment of Temporomandibular Joint Osteoarthritis by Using Arthrocentesis and Hyaluronic Acid Injections: Modified Protocol

Objective: The objective of this study is to estimate the efficacy of Arthrocentesis and hyaluronic acid injections for the treatment of temporomandibular joint osteoarthritis. Method: 20 patients with TMJ Osteoarthritis underwent a cycle of five sessions (the first session consisted of Arthrocentesis plus injection of hyaluronic acid, but they remained sessions were restricted to injection of hyaluronic acid only). The scores for preoperative maximal mouth opening, and VAS scores for pain and mastication efficiency were compared with the end of the treatment and the follow-up scores obtained by the questionnaire and clinical examination to determine the efficacy of this protocol. Results: Distinct improvements were reported for all variables during the treatment phase, and these improvements were maintained over the 9-month follow-up period. Conclusion: This study proved the usefulness of Arthrocentesis and hyaluronic acid injections performed after for the treatment of TMJ osteoarthritis and maintained these improvements over a 9-month follow-up period.

Effect of Platelet-Rich Plasma on Fibrocartilage, Cartilage, and Bone Repair in Temporomandibular Joint

The purpose of the present study was to explore the potential use of platelet-rich-plasma (PRP) in the treatment of temporomandibular joint osteoarthritis (TMJ-OA). Surgical defects were created bilaterally on the condylar fibrocartilage, hyaline cartilage, and bone to induce an osteoarthritic TMJ in rabbits. PRP was applied to the right joints of the rabbits (PRP group), and the left joints received physiologic saline (control group). After 4 weeks, the rabbits were sacrificed for histologic and scanning electron microscopy (SEM) examinations. The data were analyzed statistically. The new bone regeneration was significantly greater in the PRP group (P < .011). Although the regeneration of the fibrocartilage and hyaline cartilage was greater in the PRP group, no statistically significant difference was found between the 2 groups. SEM showed better ultrastructural architecture of the collagen fibrils in the PRP group. PRP might enhance the regeneration of bone in TMJ-OA.

Clinical signs, diagnosis and complex treatment of temporomandibular joint osteoarthritis

Aim. To improve complex treatment of temporomandibular joint osteoarthritis. Methods. 45 patients with temporomandibular joint osteoarthritis aged 18-75 years were examined. The main group consisted of 25 patients who were treated using transcranial electric stimulation. Comparison group consisted of 20 patients in whom standard treatment was applied. Control group consisted of 10 healthy volunteers and was used to compare blood cytokine and β-endorphin levels. Clinical examination, computed tomography, immunological blood analysis were performed in all patients. Results. After the complex treatment all the symptoms resolved, and the position of mandibular condyles in mandibular fossae of the temporal bone and results of immunological blood analysis normalized. The baseline level of β-endorphin of patients with temporomandibular joint osteoarthritis did not differ from control group. After transcranial electric stimulation β-endorphin serum levels were significantly raised at day 6 and especially at day 9, while in patients with standard treatment the β-endorphin serum levels were only slightly higher compared to baseline levels. Decrease of interleukin-6 serum levels was more significant in the transcranial electric stimulation group. Transcranial electric stimulation has also leaded to elevation of interleukin-10 serum levels up to normal ranges at day 9, compared to low level (5 times below normal range) at all times in the standard treatment group. After 2 years of treatment there was no symptoms of the disease, normal ranges of motion in temporomandibular joints and no relapses registered in 24 out of 25 patients from transcranial electric stimulation group compared to 11 out of 20 patients from standard treatment group. In 1 patient from transcranial electric stimulation group and 9 patients from standard treatment group clicking on the involved side was still present, those patients were re-treated. Conclusion. Usage of transcranial electric stimulation as a component of complex treatment of patients with temporomandibular joint osteoarthritis increases the effectiveness of their treatment.

Differential Regulation of Proteoglycan-4 Expression by IL-1.ALPHA. and TGF-.BETA.1 in Rat Condylar Chondrocytes

Proteoglycan 4 (PRG4) is a multifaceted glycoprotein that mediates boundary lubrication of articular cartilage and its dysregulation is associated with impaired lubrication and cartilage destruction in multiple synovial joints. However, the spatiotemporal expression of PRG4 and the associated regulatory networks remain largely unknown in the mandibular condylar cartilage that is responsible for homeostasis and functions of the temporomandibular joint. We here investigated the possible regulatory effects of the interleukin-1α (IL-1α) or/and transforming growth factor-β1 (TGF-β1) on the expression of PRG4 in primary chondrocytes that were isolated from the superficial layer of the condylar cartilage of the 20-day-old male Sprague-Dawley rats. Both IL-1α and TGF-β1 have been implicated in joint destruction and repair. Treatment of primary chondrocytes for 24 h with recombinant human (rh) IL-1α (10 ng/ml) resulted in pronounced reduction in the expression levels of PRG4 mRNA and protein, whereas stimulation with rhTGF-β1 (10 ng/ml) significantly increased the expression levels, as measured by RT-PCR and ELISA, respectively. Moreover, rhTGF-β1 was capable to antagonize the inhibitory effects on the PRG4 expression caused by rhIL-1α and robustly restored its abundance in the cultured condylar chondrocytes. Taken together, our data indicate that PRG4 is synthesized and secreted by condylar cartilage chondrocytes and its expression is differentially regulated by IL-1α and TGF-β1. The rhIL-1α-mediated PRG4 repression is reversible and potently antagonized by rhTGF-β1 in condylar chondrocytes. The observed up-regulation of PRG4 upon rhTGF-β1 treatment further supports the therapeutic application of rhTGF-β1 in the treatment of temporomandibular joint osteoarthritis.

A one-year case series of arthrocentesis with hyaluronic acid injections for temporomandibular joint osteoarthritis

The present study presents a case series on the efficacy of arthrocentesis with hyaluronic acid injections for the treatment of temporomandibular joint osteoarthritis by providing patient evaluations at a one-year follow-up. Twenty-five patients with a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD axis I group IIIb) underwent a cycle of 5 arthrocenteses with injections (1 per week) of 1 mL hyaluronic acid. A number of clinical parameters (pain at rest and mastication, masticatory efficiency, maximum nonassisted and assisted mouth openings, functional limitation, subjective efficacy, and tolerability of the treatment) were assessed by the same blinded operator at the time of the diagnosis (baseline), at each appointment during the treatment, and at 1-week, 1-month, 3-month, 6-month, and 1-year follow-up appointments. Descriptive analysis showed improvements which were maintained over time for all the study parameters. Permutation tests evidenced the significance of changes which occurred in many clinical parameters within the first 2 injections. Differences with baseline levels remained significant at the end of the follow-up period, particularly for the masticatory efficiency and pain at mastication (minimum and maximum) parameters. Data from the present investigation support findings from studies on other joints, which show the efficacy of serial injections of hyaluronic acid after arthrocentesis to reduce symptoms of osteoarthritis and to maintain improvements over time.