Chondromalacia as pathological finding in arthroscopy of the temporomandibular joint: A retrospective study

Objective

The objective of this study was to describe the arthroscopic findings of chondromalacia and its relation with the internal derangement of the temporomandibular joint (TMJ).

Does arthroscopy cause more complications than arthrocentesis in patients with internal temporomandibular joint disorders? Systematic review and meta-analysis

The objective of this study was to compare, through a systematic review with a meta-analysis, the relative risks of arthroscopy and arthrocentesis in the temporomandibular joint. MEDLINE/PUBMED, EMBASE, Cochrane Library (CENTRAL), Web of Science, SCOPUS were the researched databases, as well as grey literature and manual searches. The search results showed 656 studies, but only five met the eligibility criteria. The evaluation included 194 joints (104 patients): 101 were arthroscopy and 93 arthrocentesis. Complications were observed in four patients undergoing arthroscopy (two with temporary facial paralysis and two with prolonged cervical oedema) and in three patients undergoing arthrocentesis (two with severe bradycardia and one with prolonged cervical oedema). The meta-analysis demonstrated a relative risk of 0.99 for complications after arthroscopy compared with arthrocentesis, but the results showed no statistical differences. In conclusion, this systematic review suggests that there is no increased risk of complications with arthroscopy than arthrocentesis. When complications were present, they were temporary.     

Association between sexual maturation and anterior disc displacement of temporomandibular joint in adolescents aged 13–14 years

Clinical Oral Investigations - To investigate the association between sexual maturation and anterior disc displacement (ADD) of temporomandibular joint (TMJ). Adolescents aged...     

Roles of hypoxia inducible factor-1α in the temporomandibular joint

ObjectiveTemporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease characterized by permanent cartilage loss. Articular cartilage is maintained in a low-oxygen environment. The chondrocyte response to hypoxic conditions involves expression of hypoxia inducible factor 1α (HIF-1α), which induces chondrocytes to increase expression of vascular endothelial growth factor (VEGF). Here, we investigated the role of HIF-1α in mechanical load effects on condylar cartilage and subchondral bone in heterozygous HIF-1α-deficient mice (HIF-1α^+/−).DesignMechanical stress was applied to the TMJ of C57BL/6NCr wild-type (WT) and HIF-1α^+/− mice with a sliding plate for 10 days. Histological analysis was performed by HE staining, Safranin-O/Fast green staining, and immunostaining specific for articular cartilage homeostasis.ResultsHIF-1α^+/− mice had thinner cartilage and smaller areas of proteoglycan than WT controls, without and with mechanical stress. Mechanical stress resulted in prominent degenerative changes with increased expression of HIF-1α, VEGF, and the apoptosis factor cleaved Caspase-3 in condylar cartilage.ConclusionOur results indicate that HIF-1α may be important for articular cartilage homeostasis and protective against articular cartilage degradation in the TMJ under mechanical stress condition, therefore HIF-1α could be an important new therapeutic target in TMJ-OA.     

Test–retest reliability of MRI-based disk position diagnosis of the temporomandibular joint

This study evaluated the test–retest reliability for determining the temporomandibular joint (TMJ) disk position, diagnosed using magnetic resonance imaging (MRI). These assessments were done as a base-line measurement for a prospective cohort study, which examines the risk factors for precipitation and progression of temporomandibular disorders. Fifteen subjects (mean age, 24.2 ± 0.94 years; male/female = 8/7) were recruited from the students of Okayama University Dental School. Sagittal MR TMJ images were taken with a 1.5-T MR scanner (Magneton Vision, Siemens) in close and maximal open positions twice at about 1-week (6–11 days) interval. The images were displayed using 200% magnification on a computer screen with a commercially available image software package (OSIRIS, UIN/HCUG). Three calibrated examiners diagnosed the disk positions using the standardized criteria. The disk position of each joint was classified as normal, anterior disk displacement with or without reduction, and others. The first and second disk position diagnoses were compared, and the test–retest reliability level was calculated using the kappa index. The second disk position diagnosis was consistent with the first in 27 out of 30 joints. The calculated kappa value representing the test–retest reliability level between the first and second disk position diagnosis was 0.812. These results indicated that the test–retest reliability of MRI-based diagnosis of TMJ disk positions at about 1-week interval was substantially high, even though they were not completely consistent.     

A magnetic resonance imaging study on the temporomandibular joint disc–condyle relationship in young asymptomatic adults

The aim of this study was to assess the temporomandibular joint (TMJ) disc–condyle relationship in asymptomatic young adults. Ninety-three volunteers aged 19–23 years without temporomandibular disorder (TMD) symptoms underwent TMJ magnetic resonance imaging (MRI). The condylar centre and apex methods were used to measure and analyse the position of the disc in the oblique sagittal plane, and the reliability of the two methods was compared by calculating the intra-class correlation coefficient (ICC). Furthermore, 18 of the volunteers were randomly selected for three-dimensional (3D) reconstruction of the TMJ structure and the disc–condyle relationship. The 3D TMJ structure was established by semi-automatic segmentation of the condyle and articular disc in ITK-SNAP software; the condylar apex method was then performed. It was found that only 33.3% of the posterior edge of the articular discs were located in the normal 12 o’clock position with respect to the condyle. Moreover, this study suggests that the condylar centre method lacks accuracy when compared to the condylar apex method in regard to the measurement of the TMJ disc–condyle relationship (0 < ICC_cen < ICC_apex < 1). The position of the articular disc (left and right) was more forward in young women when compared to young men. However, there was no significant difference in the TMJ disc–condyle position between the left and right sides in the same individual, although the two joint discs in the same individual were not completely symmetrical.     

How accurate is arthroscopy of the temporomandibular joint? A comparison of findings in patients who had open operations after arthroscopic management failed

We examined the accuracy of arthroscopy to diagnose disease in the temporomandibular joint (TMJ) and to allocate an appropriate Wilkes’ stage. We compared findings made during arthroscopy with those at subsequent open operation in the same patient. Overall, arthroscopy had 87% sensitivity and 99% specificity in diagnosing disease in the TMJ, and it also accurately allocated the Wilkes’ stage (sensitivity 94%, specificity 98%).     

Relationship between microtensile bond strength and nanoleakage at the composite–dentin interface

ObjectivesThis study evaluated the relationship between microtensile bond strength (μTBS) and occurrence of nanoleakage at the resin–dentin interface using the same specimens.MethodsResin–dentin-bonded micro-specimens (sticks with a size of 300 μm × 300 μm × 8 mm) were prepared using one of two material combinations (group I: Syntac classic/Tetric Ceram Cavifil: n = 57; group II: Prime & Bond NT/Spectrum TPH: n = 52). After immersion of the micro-specimens in 0.1% rhodamine-B solution for 1 h, nanoleakage was imaged nondestructively using a confocal laser scanning microscope (CLSM). Then the specimens were subjected to a μTBS test.ResultsFor the influence of nanoleakage on μTBS with the Syntac classic/Tetric Ceram Cavifil group, the nonparametric Spearman correlation was 0.033 at p = 0.805. For the Prime & Bond NT/Spectrum TPH group, the nonparametric Spearman correlation was 0.077 at p = 0.584.SignificanceThe degree of nanoleakage had no influence on microtensile bond strength for the Syntac classic/Tetric Ceram Cavifil or for the Prime & Bond NT/Spectrum TPH group.     

Do signs of an effusion of the temporomandibular joint on magnetic resonance imaging correlate with signs and symptoms of temporomandibular joint disease?

Effusions are common among patients with disorders of the temporomandibular joint (TMJ), but publications are limited and results inconsistent about the correlation between them and important clinical variables, in particular severity of pain and degenerative disease. We organised a retrospective study of patients who presented for the evaluation and management of arthralgia of the TMJ and myofascial pain at the University of Michigan between 2011 and 2014. Inclusion criteria were: patients who had pain that was primarily arthrogenous, and coexisting myogenous pain, who had had initial non-surgical treatment, and arthroscopy of the TMJ with or without intramuscular injection of onabotulinumtoxinA (Botox,^® Allegan, Weston, Fl, USA). The primary outcome variables were pain at rest as measured by visual analogue score (VAS) and the presence of degenerative disease of the joint. The secondary outcome variables included the position of the disc and whether it was perforated, signs of synovitis, maximal interincisal opening (MIO), and duration of symptoms. We studied 47 patients (94 TMJ) who met the inclusion criteria. We found no significant differences in pain at rest before or after arthroscopy, between patients with and without effusions, or in maximal MIO or duration of symptoms between the two groups. There was, however, a significant relation between effusions and degenerative joint disease. Effusions were also associated with a lower probability of the disc being in a normal position and a higher probability of anterior disc displacement without reduction.     

Prevention and detection of prosthetic temporomandibular joint infections—update

Prosthetic joint infections are not only distressing complications for patients and surgeons, but also have an enormous financial impact on healthcare systems. The reported incidence of prosthetic joint infection is likely underestimated due to difficulties in their diagnosis. This unfortunate complication has challenged joint replacement surgeons for years, despite all the advances made in this surgical discipline. Since eradication of these infections can be very difficult, prevention remains the primary objective. Identifying recipient risk factors, adopting a proper surgical technique, appropriate wound care, optimizing the operating room environment, and appropriate postoperative care have become some of the core elements that can help to minimize the overall incidence of this complication. The purpose of this article is to provide the temporomandibular joint replacement surgeon with an update on the prevention and detection of prosthetic joint infections based on a review of the most recent information published in the orthopedic and surgical literature.     

Is there a correlation between arthroscopic findings and the clinical signs and symptoms of patients with internal derangement of the temporomandibular joint? A prospective study

The aim of this study was to evaluate the correlation between clinical signs and symptoms of patients with internal derangement of the temporomandibular joint (TMJ) and arthroscopic findings. The study included a sample of 67 patients who underwent TMJ arthroscopy. The variables evaluated were the arthroscopic findings of synovitis, chondromalacia, adhesion, and roofing. The Spearman correlation index was used to correlate these findings with the clinical signs and symptoms of internal derangement of the TMJ, namely maximum mouth opening, pain (visual analogue scale, VAS), and the Wilkes classification. The mean age of the population was 36.16 years, and 85% were female. There was a correlation between pain and synovitis (P = 0.0029, r = 0.3508), between mouth opening limitation and the amount of adhesion (P = 0.0004, r = ?0.4084), and between Wilkes classification and the presence of chondromalacia and disc displacement (P = 0.001, r = 0.374 and P = 0.0045, r = ?0.3357, respectively). No correlation was found between age and the presence of chondromalacia (P = 0.3444, r = 0.1147). Patients who had worse pain symptoms had more advanced stages of synovitis, and the increased presence of adhesions was associated with limitations in mouth opening. Furthermore, those with more advanced Wilkes stages had greater disc displacement and more severe stages of chondromalacia.     

Biomaterials in temporomandibular joint replacement: current status and future perspectives—a narrative review

The alloplastic total temporomandibular joint (TMJ) prosthesis has a long history, with many different materials and designs used. While several of these materials have proven valuable over time, many others have not been suitable for implantation, resulting in failure and the need for explantation of the implant. Because of the failure of several of these systems, the use of alloplastic prostheses has reduced dramatically, despite their advantages over autogenous restoration. The aim of this narrative review is to discuss the criteria that must be met by a biomaterial in order for it to be considered suitable for implantation, as well as the common complications that can occur. Currently used materials are highlighted, as well as potential future materials that might prove better suitable for implantation. Several surface modification techniques are proposed as an alternative to the materials used in current TMJ prosthesis systems.     

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.     

Does the procedure of arthrography affect the range of movement in patients with locking of the temporomandibular joint?

The aim of this study was to investigate whether arthrography itself altered the range of mandibular movements, in a group of patients with locking of the temporomandibular joint (TMJ). The clinical records of a series of 161 patients who were diagnosed with locking of the TMJ were retrospectively analysed. Mouth opening had improved in 57 out of 161 patients (35%). Twenty-three patients (14%) had improved by 5 mm or less. Nineteen patients (11%) had improved by more than 5 mm but less than 10 mm, whereas 15 patients (9%) had improved by more than 10 mm. Of the patients who experienced an improved mouth opening, only nine (15%) had improved from their pre-arthrography restricted maximum opening to beyond the lower limit of normal. This suggests that the injection of contrast medium had an effect on the range of vertical opening in patients with displacement of the disc without reduction.     

Is there a difference in the reliable measurement of temporomandibular disorder signs between experienced and inexperienced examiners?

AIMS: To determine whether there is a difference in terms of reliability between experienced examiners and inexperienced examiners in the measurement of signs of temporomandibular disorders (TMD). METHODS: A total of 27 patients seen for treatment of TMD were rated blindly and in random sequence by 2 experienced and 2 inexperienced examiners. The examiners participated in a 4-hour calibration session on the day preceding the reliability study. Both experienced and inexperienced examiners participated in the calibration session to reduce the effect of examiner subjectivity and allow the study focus to be on the effect of experience. The rating followed the Research Diagnostic Criteria for Temporomandibular Disorders and included mandibular movements, joint sounds, and digital palpation of muscles and joints. Intraclass correlation coefficients and kappa statistics were calculated to estimate interrater reliability. The Wilcoxon signed rank test was performed to test for differences between experienced and inexperienced examiners' results, and the Friedman test was used for differences between all 6 examiner combinations. RESULTS: Excellent overall reliability was found for vertical mandibular motions, acceptable reliability was found for the summed muscle palpation pain sites, and moderate to poor reliability was found for excursive movements, joint sounds, and single muscle palpation pain sites. No significant differences in the measurement results could be found between the experienced examiners and the inexperienced examiners. CONCLUSION: Examiner calibration rather than professional experience seems to be the most important factor for reliable measurement of TMD symptoms.