Development of the human temporomandibular joint.

A great deal of research has been published on the development of the human temporomandibularjoint (TMJ). However, there is some discordance about its morphological timing. The most controversial aspects concern the moment of the initial organization of the condyle and the squamous part of the temporal bone, the articular disc and capsule and also the cavitation and onset of condylar chondrogenesis. Serial sections of 70 human specimens between weeks 7 and 17 of development were studied by optical microscopy (25 embryos and 45 fetuses). All specimens were obtained from collections of the Institute of Embryology of the Complutense University of Madrid and the Department of Morphological Sciences of the University of Granada. Three phases in the development of the TMJ were identified. The first is the blastematic stage (weeks 7-8 of development), which corresponds with the onset of the organization of the condyle and the articular disc and capsule. During week 8 intramembranous ossification of the temporal squamous bone begins. The second stage is the cavitation stage (weeks 9-11 of development), corresponding to the initial formation of the inferior joint cavity (week 9) and the start condylar chondrogenesis. Week 11 marks the initiation of organization of the superior joint cavity. And the third stage is the maturation stage (after week 12 of development). This work establishes three phases in TMJ development: 1) the blastematic stage (weeks 7-8 of development); 2) the cavitation stage (weeks 9-11 of development); and 3) the maturation stage (after week 12 of development). This study identifies the critical period of TMJ morphogenesis as occurring between weeks 7 and 11 of development.     

Mechanical stimulation of TMJ condylar chondrocytes encapsulated in PEG hydrogels

Temporomandibular joint (TMJ) disorders are most commonly associated with TMJ disc dislocation and osteoarthritis, which can cause erosion of the articular cartilage on the head of the mandibular condyle. There has been little attention focused on treating the damaged condylar cartilage. Therefore, the overall goal of this research is to create a tissue engineering therapy for resurfacing the damaged cartilage of the condylar process with healthy living tissue. Initially, bovine condylar cartilage explants were studied to understand the tissue structure, composition, and gene expression of the native tissue. The cell response of isolated condylar chondrocytes encapsulated in photopolymerized poly(ethylene glycol) hydrogels as a tissue engineering scaffold was examined in the presence and absence of dynamic loading for up to three days of culture. Condylar chondrocyte viability was maintained within the PEG hydrogel constructs over the culture period and loading conditions. Cell response was examined through real-time RTPCR for collagen types I and II and aggrecan, nitric oxide production, cell proliferation, proteoglycan (PG) synthesis, and spatial distribution of extracellular matrix through histology. This study demonstrates that PEG hydrogel constructs are suitable for condylar chondrocyte encapsulation in the absence of loading. However, dynamic compressive strains resulted in inhibition of gene expression, cell proliferation, and PG synthesis.     

Alterations in intermediate filaments expression in disc cells from the rat temporomandibular joint following exposure to continuous compressive force

The articular disc in the temporomandibular joint (TMJ) that serves in load relief and stabilizing in jaw movements is a dense collagenous tissue consisting of extracellular matrices and disc cells. The various morphological configurations of the disc cells have given us diverse names, such as fibroblasts, chondrocyte-like cells and fibrochondrocytes; however, the characteristics of these cells have remained to be elucidated in detail. The disc cells have been reported to exhibit heterogeneous immunoreaction patterns for intermediate filaments including glial fibrillary acidic protein (GFAP), nestin and vimentin in the adult rat TMJ. Because these intermediate filaments accumulate in the disc cells as tooth eruption proceeds during postnatal development, it might be surmised that the expression of these intermediate filaments in the disc cells closely relates to mechanical stress. The present study was therefore undertaken to examine the effect of a continuous compressive force on the immunoexpression of these intermediate filaments and an additional intermediate filament - muscle-specific desmin - in the disc cells of the TMJ disc using a rat experimental model. The rats wore an appliance that exerts a continuous compressive load on the TMJ. The experimental period with the appliance was 5 days as determined by previous studies, after which some experimental animals were allowed to survive another 5 days after removal of the appliance. Histological observations demonstrated that the compressive force provoked a remarkable acellular region and a decrease in the thickness of the condylar cartilage of the mandible, and a sparse collagen fiber distribution in the articular disc. The articular disc showed a significant increase in the number of desmin-positive cells as compared with the controls. In contrast, immunopositive cells for GFAP, nestin and vimentin remained unchanged in number as well as intensity. At 5 days after removal of the appliance, both the disc and cartilage exhibited immunohistological and histological features in a recovery process. These findings indicate that the mature articular cells are capable of producing desmin instead of the other intermediate filaments against mechanical stress. The desmin-positive disc cells lacked α-smooth muscle actin (α-SMA) in this study, even though desmin usually co-exists with α-SMA in the vascular smooth muscle cells or pericytes. Because the precursor of a pericyte has such an immunoexpression pattern during angiogenesis, there is a further possibility that the formation of new vessels commenced in response to the extraordinary compressive force.     

Development of the human temporomandibular joint

A great deal of research has been published on the development of the human temporomandibular joint (TMJ). However, there is some discordance about its morphological timing. The most controversial aspects concern the moment of the initial organization of the condyle and the squamous part of the temporal bone, the articular disc and capsule and also the cavitation and onset of condylar chondrogenesis. Serial sections of 70 human specimens between weeks 7 and 17 of development were studied by optical microscopy (25 embryos and 45 fetuses). All specimens were obtained from collections of the Institute of Embryology of the Complutense University of Madrid and the Department of Morphological Sciences of the University of Granada. Three phases in the development of the TMJ were identified. The first is the blastematic stage (weeks 7–8 of development), which corresponds with the onset of the organization of the condyle and the articular disc and capsule. During week 8 intramembranous ossification of the temporal squamous bone begins. The second stage is the cavitation stage (weeks 9–11 of development), corresponding to the initial formation of the inferior joint cavity (week 9) and the start condylar chondrogenesis. Week 11 marks the initiation of organization of the superior joint cavity. And the third stage is the maturation stage (after week 12 of development). This work establishes three phases in TMJ development: 1) the blastematic stage (weeks 7–8 of development); 2) the cavitation stage (weeks 9–11 of development); and 3) the maturation stage (after week 12 of development). This study identifies the critical period of TMJ morphogenesis as occurring between weeks 7 and 11 of development. Anat Rec 255:20–33, 1999. © 1999 Wiley‐Liss, Inc.     

前交叉韧带离断骨关节炎大鼠印第安刺猬蛋白以及Runt相关转录因子2的表达

背景：印第安刺猬蛋白(Ihh)及其信号蛋白Gli1以及Runt相关转录因子2(Runx2)是骨关节炎密切相关的因子,在骨关节炎发病过程中,是引起关节退行性改变的重要原因之一。 目的：探索Ihh,Gli1以及Runx2在骨关节炎发病过程中的作用。 方法：将30只SD大鼠随机分成对照组(n=10)和模型组(n=20)。模型组大鼠取一侧膝关节行前交叉韧带离断建立骨关节炎模型,分别于造模后4周及12周,各取10只大鼠进行观察。对照组大鼠仅暴露前交叉韧带,于术后12周进行观察。 结果与结论：与对照组相比,造模4周后可见骨关节炎模型大鼠膝关节出现软骨退变,膝关节软骨中Ihh,Gli1及Runx2表达水平明显增高,而造模12周后软骨退变进一步加重,但膝关节软骨中Ihh,Gli1及Runx2表达水平下降。提示Ihh,Gli1及Runx2在骨关节炎退变过程中起重要作用,其表达水平在骨关节炎的早期即明显升高,可作为骨关节炎防治研究中的评价指标。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

颞下颌关节被动运动时的轴心

采用5具尸体头颅,取其半侧,切除皮肤和肌肉,先保留韧带,再除去韧带,分别拍摄从咬(牙合)位至大张口位共8个位置的X光片。以探讨颢下颌关节在被动运动时的轴心位置。在除去韧带的情况下,髁突绕本身的轴作中心定轴转动,该中心位于髁嵴下方6毫米处,运动发生在髁突与关节盘之间。在保留韧带的情况下,下颌张口运动也是定轴转动,轴心位于髁嵴下方约12毫米处的Q点,髁突绕偏心的Q点转动,同时带动关节盘一起向前下滑动。     

Comparative histological contributions to the development of the ear-ossicular joints and the temporomandibular joint in the mouse

The genesis, differentiation, development and growth of the ear-ossicular joints and temporomandibular joint (TMJ) in the Slc-ICR mouse were studied by means of light and transmission electron microscopy. The differentiation of the ossicular joints and TMJ anlagen was initiated during the fetal stages. Although morphogenesis, development and growth of the TMJ were already evident in the prenatal stages, the joint-cleaving associated with the occurrence of interzones in the cartilaginous ossicular chain was observed during the neonatal stages. However, the simple diarthrodial ossicular joints were completed and became mature earlier than the double synovial TMJ having an articular disc in early postnatal life. TEM examinations revealed that the articulating epiphyseal cartilage of the ossicular joints consisted of hyaline cartilage, while the intracapsular structures in the TMJ were composed of fibrocartilage. The synovium of the diarthroidal joints was supplied by blood vessels, nerve fibers, collagen and elastic fibers. No distinct aging in the cellular and fibrous components of the synovial tissue of the completed TMJ and ossicular joints was evident in the present study.     

Genes that regulate morphogenesis and growth of the temporomandibular joint: A review

Compared with the joints of the limbs, our understanding of the genes that regulate development and growth in the temporomandibular joint (TMJ) is fairly limited. Because the morphogenesis of the secondary cartilage and other intra‐articular structures in the TMJ occurs later and in a different manner than in the limbs, the genetic control of TMJ development might reasonably be assumed to differ from that in the limbs. However, studies of the specific genes regulating TMJ morphogenesis and growth have only begun to appear in the literature within the last decade. This review attempts to survey and interpret the existing knowledge on this topic and to suggest fruitful avenues of investigation for the future. Studies to date using knockout and over‐expression of candidate genes suggest that a developmental hierarchy of joint structures exists, with condyle development primary. A hierarchy of gene expression also exists: Runx2 and Sox9 expression is critical for condylar cartilage formation. Several of the other genes discussed in this report may regulate TMJ morphogenesis by affecting Sox9 and Runx2 expression and control the ihh‐PTHrP axis by means of these genes. Developmental Dynamics 243:864–874, 2014. © 2014 Wiley Periodicals, Inc.     

上颌扩弓对颞下颌关节应力影响的有限元分析

目的 通过三维有限元法对比扩弓前和放置扩弓器时颞下颌关节(temporomandibular joint, TMJ)内部各组织应力分布情况。方法 根据1名上颌牙弓狭窄患者CBCT影像资料,构建扩弓前和包含扩弓器的TMJ三维有限元模型,对模型加载相同的肌力和边界约束,观察TMJ髁突、关节盘、关节窝的等效应力、最大主应力和最小主应力。结果 扩弓前TMJ等效应力主要分布在下颌支前缘、髁突前斜面、关节盘中间带和后带以及关节窝顶部。放置扩弓器时,TMJ应力分布特征与扩弓前基本一致,应力虽然明显增加,但应力分布区域更加均匀;髁突和关节盘应力向前、向外侧移动,髁突后斜面表现出更加均匀的最大主应力分布范围。结论 上颌扩弓器产生的矫形力能够使TMJ应力增加,诱导髁突发生组织改建,协调髁突和关节盘的关系。临床上对于牙弓狭窄的患者应该采用合适的手段进行扩弓矫治。     

颞下颌关节的生物力学

颞下颌关节是人体最为复杂,精细的关节之一,具有负重的功能,关节软骨是具有低渗透性的多孔粘弹性介质,生理状态下在软骨内部存在胶原－蛋白多糖－水凝胶网状结构应力缓冲系统。关节盘是特殊类型的结缔组织,不属纤维软骨,是髁突和关节窝之间的应力集中缓冲器。关节盘后组织具有高度的顺应性,在关节运动中发挥容积补偿作用,关节外侧壁是囊－韧带结构的复合体,拉伸强度和拉伸刚度较弱,长期的口腔副功能易使结构处于超负荷状态     

Developmental patterning in chondrocytic cultures by morphogenic gradients: BMP induces expression of Indian hedgehog and Noggin

BACKGROUND: The maturation of chondrocytes is essential for endochondral bone formation. The Indian Hedgehog (Ihh) gene is expressed in prehypertropic chondrocytes and has been proposed to regulate chondrocyte maturation. While such secretary factors as PTHrP and BMP are thought to be involved in Ihh expression, the mechanism of the restricted expression of Ihh is not clear. RESULTS: Using primary chondrocytes, we have developed here a modified micromass culture (MM-C) system that allows the formation of concentration gradients of secreted factors, expressed either endogenously or retrovirally, from each of plural micromass cultures on a single plate. Using this system, we determined that chondrocytes create the inhibitory micro-environment, partly dependent on PTHrP secretion, for the Ihh expression. We also showed that retrovirally induced BMP-2 induces the expression of both Ihh and Noggin (encoding the BMP-inactivating protein), and we further present evidence that a negative-feedback loop involving Noggin might account for the precise localization of BMP signalling for Ihh induction. CONCLUSION: These results suggest that the expression of the Ihh gene in cartilage is regulated by several mechanisms that include the secretion of inhibitory factors (including PTHrP) and the negative-feed back loop formed by BMPs and Noggin.     

Three-dimensional finite element analysis of human temporomandibular joint with and without disc displacement during jaw opening

The aim of this study was to evaluate the differences of stress distribution in the temporomandibular joint (TMJ) disc during jaw opening between the subjects with and without internal derangement of TMJ (TMJ-ID). Three symptom-free volunteers and three symptomatic patients with anterior disc displacement were selected as normal and TMJ-ID subjects, respectively. For each subject, magnetic resonance images (MRI) were taken in the axial, sagittal and coronal directions. Using MRI taken, six three-dimensional finite element models of TMJ were developed. For each subject, the condylar movements during jaw opening were recorded and used as the loading condition for stress analysis. By comparing the calculated disc displacement to the measured one from MRI, the frictional coefficients were mu = 0.001 for the normal subjects, but mu = 0.01-0.001 for the TMJ-ID subjects. For the normal subjects, relatively high stresses were found at the anterior and lateral portions of the disc throughout jaw opening. In the connective tissues, the stress level was higher in the TMJ-ID than in the normal subjects. It is suggested that the disc displacement induces the change of stress distribution in the disc and the increase of frictional coefficients between articular surfaces, resulting in the secondary tissue damage.     

关节盘移位对颞下颌关节内应力分布的影响

目的 通过对不同关节盘移位的数值模拟,探究各种移位情况下颞下颌关节（temporomandibular joint,TMJ）内各结构的应力分布规律。方法 依据CT图像,建立包含下颌骨、全牙列、关节盘和关节软骨的正常TMJ三维有限元模型;参考关节盘前、后、外、内移位的临床特征,建立对应的4个模型。关节盘与关节软骨间考虑接触,用缆索元模拟下颌韧带和关节盘附着,施加正中咬合荷载。结果 前移位将导致关节盘中带产生过高的压应力,达到3.23 MPa;后、内、外移位时关节盘的整体应力水平比前移位和正常TMJ高;各种移位都使关节结节后斜面的应力值大幅度增加,但对髁突关节面的影响却不大。结论 各种移位都将导致关节盘和关节结节后斜面产生过高的应力,且后、内、外移位更为危险,更容易造成关节结构和功能的损伤。     

颞下颌关节盘前移位对髁状突软骨中纤溶酶原激活剂系统表达的影响

目的研究颞下颌关节盘前移位对关节软骨组织中尿激酶型纤溶酶原激活剂（uPA）系统的影响.方法24只日本大耳白兔在不打开关节囊的情况下建立右侧颞下颌关节盘前移位动物模型,分别于术后4、1、2、4、8d和12周各处死4只动物.常规HE染色观察髁突软骨的形态学变化,并以原位杂交法检测髁突软骨细胞中uPA和纤溶酶原激活剂抑制剂-1（PAI-1）的基因表达变化.结果术后髁突受力区出现一过性的软骨变薄、各层排列紊乱等病理变化.uPA和PAI-1基因转录水平在术后即开始上调,至2周时达到最高水平,至12周时基本恢复至正常水平,与髁突软骨的适应性改建相一致.结论颞下颌关节盘前移位后,关节软骨内uPA系统的变化与关节软骨的适应性改建密切相关.     

Lubrication of the Temporomandibular Joint

Although tissue engineering of the temporomandibular joint (TMJ) structures is in its infancy, tissue engineering provides the revolutionary possibility for treatment of temporomandibular disorders (TMDs). Recently, several reviews have provided a summary of knowledge of TMJ structure and function at the biochemical, cellular, or mechanical level for tissue engineering of mandibular cartilage, bone and the TMJ disc. As the TMJ enables large relative movements, joint lubrication can be considered of great importance for an understanding of the dynamics of the TMJ. The tribological characteristics of the TMJ are essential for reconstruction and tissue engineering of the joint. The purpose of this review is to provide a summary of advances relevant to the tribological characteristics of the TMJ and to serve as a reference for future research in this field. This review consists of four parts. Part 1 is a brief review of the anatomy and function of the TMJ articular components. In Part 2, the biomechanical and biochemical factors associated with joint lubrication are described: the articular surface topology with microscopic surface roughness and the biomechanical loading during jaw movements. Part 3 includes lubrication theories and possible mechanisms for breakdown of joint lubrication. Finally, in Part 4, the requirement and possibility of tissue engineering for treatment of TMDs with degenerative changes as a future treatment regimen will be discussed in a tribological context.     

不同稳定咬合板厚度对可复性前移位患者颞下颌关节应力分布影响

目的 利用三维有限元方法比较双侧颞下颌关节(temporomandibular joint, TMJ)可复性前移位(anterior disc displacement with reduction, ADDwR)患者在佩戴两种不同厚度稳定性咬合板后紧咬时TMJ应力分布改变。方法 根据患者CT、MRI影像数据,依次构建ADDwR患者牙尖交错位(工况1)与戴3、5 mm稳定咬合板咬合(工况2、3)时共3个TMJ有限元模型。分别给予3种工况中的下颌骨施加最大肌力60 s,之后对各工况中关节窝和髁突软骨表面、关节盘表面及双板区的最大等效应力进行评估。结果 各工况左侧TMJ内各结构等效应力均大于右侧。戴3 mm咬合板后,双侧关节盘均未发生复位,关节盘应力仍旧集中在后带及双板区,双侧关节软骨表面应力显著增加;戴5 mm咬合板后,右侧关节盘复位,关节盘最大应力位于中间带,关节软骨和双板区等效应力降低约40%,左侧关节盘未复位,关节窝软骨和双板区等效应力下降约6%。结论 ADDwR患者佩戴不同厚度咬合板,TMJ内应力及其分布模式均发生改变;5 mm稳定性咬合板可以减小ADDwR患者关节窝软骨及双板区...     

颞下颌关节可复性盘前移患者的MR表现

目的:研究颞下颌关节可复性盘前移（ADDWR）患者的磁共振（MR）成像表现。方法:纳入颞下颌关节ADDWR患者55例作为观察组,另纳入30例牙齿排列整齐的健康志愿者作为对照组。所有研究对象均接受MR成像检查,记录颞下颌关节ADDWR患者关节盘前移程度,比较不同严重程度患者关节盘形态和关节渗出情况。结果:55例颞下颌关节ADDWR患者中,轻症35例,重症20例。对照组、轻症组及重症组关节盘形态分型比较,差异有统计学意义（P<0.05）。3组对象颞下颌关节渗出情况比较,差异有统计学意义（P<0.05）。不同程度关节渗出患者视觉模拟评分法（VAS）评分差异有统计学意义（P<0.05）。3组对象关节盘长度差异有统计学意义（P<0.05）。轻度组关节盘前移度较重症组显著减轻,差异有统计学意义（P<0.05）。结论:MR有助于颞下颌关节ADDWR患者病情判断,可为临床治疗提供依据。     

Age-related changes in the microarchitecture of collagen fibrils in the articular disc of the rat temporomandibular joint

The microarchitecture of collagen fibrils in the articular disc of the temporomandibular joint (TMJ) plays an important role in dissipating the mechanical load during jaw movement. However, little information is available on its adaptations to the biomechanical environment during development. To address this issue, we analyzed the diameter of collagen fibrils of the articular disc of the rat TMJ with quantitative ultrastructural analysis during postnatal development. The mean diameter of the collagen fibrils significantly increased and the arrangement of the collagen fiber networks became compact during development. Articular discs of suckling rat pups were composed of thin, uniformly sized collagen fibrils (range: 30-60 nm, peak: 40-50 nm). At the age of 4 weeks, thicker collagen fibrils began to appear in articular discs, shortly after weaning (range: 20-70 nm, peak: 40-50 nm). In articular discs of adult rats, collagen fibrils varied widely in diameter, with thick fibrils predominating (range: 10-120 nm, peak: 40-70 nm). These age-related changes in the microarchitecture of collagen fibrils in articular discs may reflect changes in their biomechanical environment during development.