Decreased bone marrow stromal cells activity involves in unilateral anterior crossbite-induced early subchondral bone loss of temporomandibular joints

Objective

Subchondral bone loss in mandibular condyles was reported to be induced by experimentally created unilateral anterior crossbite (UAC) which altered the occlusal load distribution and hereafter the temporomandibular joint (TMJ) remodelling process. However, the initial cellular responses are poorly understood. In the present study, changes in osteoblast and osteoclast activities in TMJ subchondral bone were investigated using the rats treated with UAC.

Design

Forty rats were randomly divided into UAC and control groups, and sampled at 2 weeks after the operation. Subchondral bone loss was evaluated by micro-CT. Osteoclast and osteoblast activities were analyzed by real-time PCR. The osteoblast differentiation of the locally isolated BMSCs from TMJ subchondral bone was assessed by Alizarin red staining. The migration of BMSCs was detected by transwell assays.

Results

Compared with the age-matched controls, TMJ subchondral bone loss was observed in the UAC-treated rats (p < 0.05). The osteoblast activity evaluated by real-time PCR and osteoblast number revealed by immunohistochemical staining were reduced in the TMJ subchondral bone of UAC rats (p < 0.05), and the capability of proliferation, migration and osteoblast differentiation were all decreased in the locally isolated BMSCs from the UAC group (p < 0.05).

Conclusions

The present data demonstrated an involvement of reduced BMSCs activity in the initiation of the mandibular subchondral bone loss at the early stage of installation of the aberrant prostheses.     

Low-level laser therapy for management of TMJ osteoarthritis

Aims:

This study investigated the efficacy of low-level laser therapy (LLLT) for the management of temporomandibular joint (TMJ) osteoarthritis.

Methodology:

In a double-blind clinical trial, 20 patients with TMJ osteoarthritis were randomly divided into laser and placebo groups. The patients in the laser group received irradiation from an 810 nm low-level laser (Peak power 80 W, average power 50 mW, 1500 Hz, 1 μs pulse width, 120 seconds, 6 J, 3·4 J/cm² per point), which was applied on four points around the TMJs and on painful muscles three times a week for 4 weeks. In the placebo group, the treatment was the same as that in the laser group, but with laser simulation. The patients were evaluated before laser therapy (T1), after 6 (T2) and 12 (T3) laser applications and 1 month after the last application (T4), and the amount of mouth opening and the pain intensity were recorded.

Results:

No significant differences were found in mouth opening either between the study groups or between the different evaluation times in each group (P>0·05). There was no significant difference in pain symptoms of the masticatory muscles and TMJ between the laser and the placebo groups (P>0·05), but some significant within-group improvements were present for Visual Analogue Scale (VAS) scores of the body of the masseter and TMJ in both groups.

Conclusions:

LLLT using the present laser parameters was no more effective than the placebo treatment for reducing pain and improving mouth opening in patients with TMJ osteoarthritis.     

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目的评价伴有颞下颌关节紊乱病（TMD）症状的错铪患者使用拾板治疗的效果。方：去对2011年4-11月福建医科大学附属口腔医院正畸科就诊的41例伴有TMD症状的错矜畸形患者使用耠板治疗,应用颅颌指数（CMI）定量分析治疗前后的颞下颌关节（TMJ）状态。结果41例患者经3个月铪板治疗后的功能障碍指数（DI）和CMI均较治疗前明显下降,差异有统计学意义（P〈0．001）;而触诊指数（PI）在治疗前后的差异无统计学意义（P〉0．05）。结论袷板治疗可明显改善错袷畸形患者TMJ功能状态。     

MRI分期与TMD临床症状相关性的分析

目的 评估颞下颌关节紊乱病（temporomandibular disorder, TMD）磁共振成像（MRI）分期与临床症状的相关性。方法 通过回顾性队列研究,收集2018年12月—2019年12月至我院颌面外科就诊的160例患者的基本信息、MRI影像、数据化测定（VAS）评分表以及张口度。将患者根据年龄分组（12~18、18~40、40~70岁）,分析不同分期的TMD患者分布情况。分析患者性别与TMD分期的相关性,并分析TMD患者分期（Ⅱ~Ⅳ期）与VAS、最大张口度的相关性。对测量数据进行Wilcoxon秩和检验。结果 Ⅱ~Ⅴ期患者张口度分别为（31.22±9.40）、（20.77±6.51）、（29.39±5.81）和（22.41±9.18）mm,Ⅱ期与Ⅲ、Ⅴ期张口度有明显差异（P<0.05）;Ⅱ~Ⅴ期患者VAS评分为20.47±11.30、64.48±23.51、51.34±20.47和45.61±16.38,Ⅲ期与Ⅱ期比有统计学差异（P<0.05）。结论 MRI能够准确地反应TMD患者的盘-髁关系。基于MRI的TMD分期与TMD临床症状具有相关性。Ⅲ期患者疼痛症状最为明显,Ⅲ期及Ⅴ期患者张口受限较为明显。     

A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder

BackgroundTemporomandibular pain has multiple etiologies and a range of therapeutic options. In this pilot study, the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporomandibular disorders (TMDs).MethodsThe authors assigned 80 participants randomly into one of the following four groups, all of which included a comprehensive self-care program: reversible interocclusal splint therapy (RIST), Activator Method Chiropractic Technique (AMCT) (Activator Methods International, Phoenix), sham AMCT and self-care only. They made assessments at baseline and at month 2 and month 6, including use of the Research Diagnostic Criteria for Temporomandibular Disorders.ResultsThe authors screened 721 potential participants and enrolled 80 people; 52 participants completed the six-month assessment. The adjusted mean change in current pain over six months, as assessed on the 11-point numerical rating scale, was 2.0 (95 percent confidence interval, 1.1–3.0) for RIST, 1.7 (0.9–2.5) for self-care only, 1.5 (0.7–2.4) for AMCT and 1.6 (0.7–2.5) for sham AMCT. The authors also assessed bothersomeness and functionality.ConclusionsThe authors found the study design and methodology to be manageable. They gained substantial knowledge to aid in conducting a larger study. AMCT, RIST and self-care should be evaluated in a future comparative effectiveness study.Practical ImplicationsThis pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD.     

颞下颌关节紊乱病的心理因素的研究

目的：探讨心理因素在颞下颌关节紊乱病(TMD)发病机制中的作用。方法：采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和明尼苏达多项人格量表(MMPI)对颞下颌关节紊乱病患组和正常对照组各30例进行调查。结果：TMD患组与对照组相比，具有较高的焦虑和抑郁得分；MMPI测试结果显示，在MMPI十项临床量表中，患组在其中的疑病(HS)、抑郁(D)、癔病(HY)、精神病态(PD)、精神衰弱(PT)、精神分裂(SC)、社会内-外向(SI)七项中得分均高于对照组。另外，患组有26例临床量表中的一项或多项得分高于常模分数，说明TMD患的人格有偏离现象。结论：颞下颌关节紊乱病患的情绪障碍以及人格特征在其发病机制中具有重要作用。     

An epidemiological study of temporomandibular disorders in university students of Taiwan

A total of 2033 university students were surveyed for the prevalence of TMD in Taiwan. It was found that 42.9% of the students had one or more signs related to TMD, and females were slightly more frequently found. Clicking of the joint was the most common sign. Occlusal factors such as balancing contact, dental restoration, molar guidance in eccentric movement, etc., were more often found in the TMD group. Scores on stress, general anxiety, emotion and anger were higher in the TMD group while tension, ambition, depression, competition and test anxiety were not as significant. Although the prevalence of TMD in this population is high, the severity and treatment demands are low.     

老年人颞下颌关节紊乱病的(牙合)重建治疗

目的:观察(牙合)重建治疗老年人颞下颌关节紊乱病的临床疗效.方法:采用暂时性咬合板治疗26例因后牙缺失或重度磨耗所导致的老年TMD患者,3个月后待症状缓解时以金属烤瓷冠桥或可摘局部义齿对其进行永久性(牙合)重建治疗,随访时间(牙合)重建后3个月至3年.结果:戴暂时性咬合板3个月时,患者疼痛、弹响、张口受限症状消失分别为80.7%、56.5%和70.6%;永久性(牙合)重建后随访以上各项指标为88.4%、69.6%和82.3%.结论:(牙合)重建治疗对于老年人因后牙缺失及重度磨耗所致的TMD是一种有效的保守治疗方法.