Evaluation of the relationship between the attachment type of lateral pterygoid muscle and the position of temporomandibular joint disc in patients with temporomandibular joint disorders based on wireless amplified MRI detector high resolution imaging / 中华口腔医学杂志

Objective: To explore the correlation between the attachment type of lateral pterygoid muscle (LPM) and the position of temporomandibular joint (TMJ) disc in patients with temporomandibular disorders (TMD) by using wireless amplified magnetic resonance imaging detector (WAND) coupled with conventional head and neck joint coil for high resolution imaging of TMJ. Methods: Eighty-five patients with TMD diagnosed by oral and maxillofacial surgeons of Guizhou Provincial People's Hospital from October 2019 to January 2022 were collected. A total of 160 TMJ were included. There were 16 males and 69 females, aged (32.7±14.2) years. All patients were scanned with open, closed oblique sagittal and coronal WAND coupled head and neck coils with bilateral TMJ. Based on TMJ and LPM high resolution imaging, to explore the correlation between LPM attachment types and the position of TMJ disc in TMD patients, and to evaluate the potential clinical value of LPM attachment types in TMD patients. χ2 test and Pearson correlation analysis were used to evaluate the correlation between LPM attachment type and TMJ disc location. Results: There were three types of LPM attachment: type Ⅰ in 51 cases [31.9% (51/160)], type Ⅱ in 77 cases [48.1% (77/160)] and type Ⅲ in 32 cases [20.0% (32/160)]. There was a significant correlation between the type of LPM attachment and the position of articular disc (χ2=28.20, P=0.002, r=0.776). There was no statistical significance between the type of LPM attachment and the reversible displacement of articular disc (χ2=0.24, P=0.887, r=0.825). Conclusions: There is a correlation between the attachment type of LPM and the position of the disc in TMD patients. WNAD coupled with conventional head and neck joint coil TMJ high resolution scan can provide reliable imaging evidence for TMD patients in evaluating the type of LPM attachment and the location of disc.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Kindlin-2 loss in condylar chondrocytes causes spontaneous osteoarthritic lesions in the temporomandibular joint in mice / 国际口腔科学杂志·英文版

The progressive destruction of condylar cartilage is a hallmark of the temporomandibular joint (TMJ) osteoarthritis (OA); however, its mechanism is incompletely understood. Here, we show that Kindlin-2, a key focal adhesion protein, is strongly detected in cells of mandibular condylar cartilage in mice. We find that genetic ablation of Kindlin-2 in aggrecan-expressing condylar chondrocytes induces multiple spontaneous osteoarthritic lesions, including progressive cartilage loss and deformation, surface fissures, and ectopic cartilage and bone formation in TMJ. Kindlin-2 loss significantly downregulates the expression of aggrecan, Col2a1 and Proteoglycan 4 (Prg4), all anabolic extracellular matrix proteins, and promotes catabolic metabolism in TMJ cartilage by inducing expression of Runx2 and Mmp13 in condylar chondrocytes. Kindlin-2 loss decreases TMJ chondrocyte proliferation in condylar cartilages. Furthermore, Kindlin-2 loss promotes the release of cytochrome c as well as caspase 3 activation, and accelerates chondrocyte apoptosis in vitro and TMJ. Collectively, these findings reveal a crucial role of Kindlin-2 in condylar chondrocytes to maintain TMJ homeostasis.

Hábitos parafuncionais e sintomatologia de pacientes submetidos a intervenções buco-maxilo-faciais em uma clínica escola de fisioterapia: um estudo retrospectivo de 15 anos / PARAFUNCTIONAL HABITS AND SYMPTOMATOLOGY OF PATIENTS SUBMITTED TO BUCO-MAXILLO-FACIAL INTERVENTIONS IN A PHYSIOTHERAPY SCHOOL CLINIC: A RETROSPECTIVE STUDY OF 15 YEARS

Objetivo: Comparar clinicamente os pacientes com desordens buco-maxilo-faciais (DBMF) atendidos em uma clínica-escola de fisioterapia da cidade de Fortaleza. Materiais e métodos: Dentre 5.357 prontuários, foram coletados os dados de 315 prontuários referentes aos pacientes acometidos por DBMF, dentre eles, 62 homens e 253 mulheres. Resultados: O estudo adotou perfil predominante de pacientes do gênero feminino, solteiros, entre 21 a 30 anos, estudantes, que fizeram uso de relaxante muscular; mulheres sentiram dor irradiada, já homens, dor do tipo fina. Bruxismo/endentações/desgaste dentário foram prevalentes em ambos os sexos e os sintomas que apresentaram diferença estatística entre homens e mulheres foram cervicalgia (p=0,0051), cefaleia (p<0,0001), formigamento de membros superiores (p=0,0371) e dor corporal (p=0,0234). Conclusão: Bruxismo/endentações/desgaste dentário foram os prevalentes em ambos os sexos. Entre os homens, o sintoma mais prevalente foi a dor ou cansaço ao mastigar, já entre as mulheres foi a cefaleia.

The Role of Magnetic Resonance Imaging of the Temporomandibular Joint to Investigate Tinnitus in Adults with Temporomandibular Joint Disorder: A Comparative Study

Abstract Introduction The prevalence of tinnitus is higher in individuals with temporoman- dibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus. Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus. Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images. Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups. Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD.

Dimension and morphology of the mandibular condyle in class I patients in cone beam computed tomography / Dimensión y morfología del cóndilo mandibular en pacientes de clase I en tomografía computarizada de haz cónico

To evaluate the anterior-posterior (A-P)/medial-lateral (M-L) dimension, and morphology of the mandibular condyle in patients aged 18 to 65 years with Class I skeletal pattern on Cone Beam CT scans. Materials and Methods: Seventy one scans were evaluated using RealScan 2.0 software. The dimension was determined by points A (most anterior in the sagittal plane), P (most posterior in the sagittal plane), M (most interior in the coronal plane), L (most exterior in the coronal plane). The morphology of the condyle was evaluated in two coronal and sagittal planes, being classified as: round, flat, convex or mixed. The size of the condyle was analyzed by descriptive statistics and the morphology by frequency distribution. For the bivariate analysis, the Student's t-test was applied. Results: Measurements were obtained for the A-P diameter of the right condyle (RC) (8.72mm ± 1.25mm) and the left condylar (LC) (8.50mm ± 1.50mm), the M-L diameter of the RC (19.24mm ± 2.03mm) and the LC (18.97mm ± 1.87mm). There were significant differences in the male M-L dimension of the LC compared to the female (p=0.002). The most prevalent morphology of RC (35.21) and IQ (23.94) in the coronal plane was round. Conclusion: The A-P dimension of the right and left condyle is similar in both genders; however, there are differences in the M-L dimension of the left male condyle. The most prevalent morphology of the right and left condyle was round in the sagittal plane with the exception of the coronal plane.

Evaluar la dimensión antero- posterior (A-P)/medio-lateral (M­L), y la morfología del cóndilo mandibular en pacientes de 18 a 65 años con patrón esquelético Clase I en tomografías computarizadas Cone Beam. Material y Métodos: 71 tomografías fueron evaluadas mediante el software RealScan 2.0. La dimensión fue determinada por los puntos A (más anterior en el plano sagital), P (más posterior en el plano sagital), M (más interno en el plano coronal), L (más externo en plano coronal). Se evaluó la morfología del cóndilo en dos planos coronal y sagital, clasificándose en: redonda, aplanada, convexa y mixta. La dimensión del cóndilo fue analizada por estadística descriptiva y la morfología mediante distribución de frecuencias. Para el análisis bivariado, se aplicó la prueba de t de Student. Resultado: Se obtuvieron las medidas del diámetro A-P del cóndilo derecho (CD) (8,72mm ± 1,25mm) y el izquierdo (CI) (8,50mm ± 1,50mm), el diámetro M-L del CD (19,24mm ± 2,03mm) y el CI (18,97mm ± 1,87mm). Hubo diferencias significativas en la dimensión M-L del CI del sexo masculino en comparación al femenino (p=0.002). La morfología más prevalente del CD (35,21) y CI (23,94) en plano coronal fue de tipo redonda. Conclusión: La dimensión A-P del cóndilo derecho e izquierdo es similar en ambos sexos; sin embargo, existen diferencias en la dimensión M-L del cóndilo izquierdo del sexo masculino. La morfología del cóndilo derecho e izquierdo más prevalente fue la redonda en plano sagital a excepción del plano coronal.

Relación entre Síntomas de Trastornos Témporomandibulares Auto-Reportados y el Movimiento Mandibular de Sujetos Adultos Jóvenes / Relationship Between Symptoms of Self-Reported Temporomandibular Disorders and Mandibular Movement of Young Adult Subjects

RESUMEN: Tanto la limitación del movimiento mandibular como el auto reporte de síntomas de trastornos témporomandibulares (TTM) son utilizados como elementos para el diagnóstico de pacientes en la clínica. Sin embargo, la relación entre la presencia de síntomas y el movimiento mandibular no está del todo clara. Por ello, el objetivo de este estudio fue relacionar la presencia de síntomas asociados a TTM con el movimiento mandibular en una muestra de sujetos adultos jóvenes y sanos. En este estudio exploratorio participaron 40 estudiantes de Odontología, médicamente sanos, con arco dentario maxilar y mandibular continuo y completo (hasta el primer molar). A cada uno se les solicitó responder un cuestionario de auto-reporte de síntomas asociados a TTM recomendado por la American Academy of Orofacial Pain (AAOP). También se realizó un registro y análisis de sus movimientos mandibulares utilizando articulografía electromagnética 3D, con el objetivo de correlacionar la presencia de síntomas con el rango y trayectoria de apertura, y el área comprendida en lo que se describe como polígono de Posselt en el plano frontal y sagital. No se encontraron diferencias significativas entre las respuestas a cada pregunta entre hombres y mujeres. De acuerdo a las respuestas y según Delcanho (1994), 12 participantes resultaron necesitar una evaluación más exhaustiva. En este grupo se encontró que el área del polígono de Posselt en el plano frontal, fue significativamente menor que el de aquellos participantes que no requieren una evaluación más exhaustiva (p=0,003). Los valores de la trayectoria de apertura mandibular varían según de que síntoma se trate. Los principales síntomas que afectarían los valores de los movimientos bordeantes son la "dificultad para abrir la boca" y el "ruido en las articulaciones mandibulares". Con este estudio, hemos puesto de manifiesto que la limitación del movimiento mandibular como signo de TTM debe evaluarse con cautela, debido a que según la presencia de determinados síntomas y otras características de los sujetos (como el sexo), su valor podría variar.

ABSTRACT: Both the limitation of mandibular movement and the self-report of symptoms of temporomandibular disorders (TMD) are used for the diagnosis of patients in clinical diagnosis. However, the relationship between the symptoms and mandibular movement is not entirely clear. Therefore, the objective of this study was to relate the presence of symptoms associated with TMD with mandibular movement in a sample of young and healthy adult subjects. This exploratory study involved 40 medically healthy dentistry students with a continuous and complete maxillary and mandibular arch (up to the first molar). Each subject was asked to answer a self-report questionnaire for symptoms associated with TTM recommended by the American Academy of Orofacial Pain (AAOP). We also recorded and analyzed their mandibular movements using 3D electromagnetic articulography, with the aim of correlating the presence of symptoms with the range and trajectory of opening, and the area included in what is described as a polygon of Posselt in the frontal and sagittal plane. No significant differences were found between the answers to each question between men and women. According to the responses and to Delcanho, 12 participants turned out to need a more exhaustive evaluation. In this group it was found that the area of the Posselt polygon in the frontal plane was significantly smaller than that of those participants who did not require a more extensive evaluation (p = 0.003). The values of the mandibular opening path vary depending on the symptom involved. The main symptoms that would affect the values of the bordering movements are the "difficulty to open the mouth" and "noise in the mandibular joints". With this study, we have shown that the limitation of mandibular movement as a sign of TMD should be assessed with caution, as, according to the presence of certain symptoms and other characteristics of subjects (such as sex), its value may vary.

Desafíos de la Red Asistencial Pública de Chile en la Especialidad de Trastornos Temporomandibulares y Dolor Orofacial / Challenges of the Chilean Public Health Care System Network in the Temporomandibular Disorders and Orofacial Pain Specialty

RESUMEN: Los Trastornos Temporomandibulares (TTM) son un conjunto de patologías musculares y articulares que afectan al sistema masticatorio. Según estadísticas nacionales, la prevalencia de al menos un diagnóstico de TTM en la población adulta corresponde al 49,6 %, mientras que el 19,6 % padece de un dolor temporomandibular severo. La atención de pacientes afectados por estos trastornos corresponde al odontólogo especialista en trastornos temporomandibulares y dolor orofacial (TTM y DOF), especialidad reconocida legalmente desde el año 2013 por el decreto 8 del Ministerio de Salud. Estas patologías no están incorporadas a las prestaciones de salud oral de las Garantías Explícitas en Salud (GES) y recientemente se han comenzado a establecer protocolos de derivación a la especialidad desde la Atención Primaria Odontológica. En el presente estudio se realiza un análisis de la situación actual de la especialidad de TTM y DOF en la red pública de atención y se plantean posibles soluciones y mejoras a los problemas encontrados.

ABSTRACT: Temporomandibular Disorders (TMD) comprise a heterogenous group of muscle and joint disorders that affect the masticatory system. According to national statistics, the prevalence of at least one diagnosis of TMD in the adult population is 49.6 %, while 19.6 % suffers from severe temporomandibular pain. Care of patients affected by these disorders corresponds to the dentist specialized in temporomandibular disorders and orofacial pain (TMD and OFP); these particular disorders and the specialty were incorporated by the Ministry of Health in 2013.. The pathologies are not incorporated in the Explicit Health Care Guarantees (GES) and only recently protocols for a referral program were established for Primary Dental Care in this area. In this study, the present situation of the specialty of TMD and OFP in the public health care network is analyzed, as well as possible solutions and improvements to the difficulties encountered therein.

Differences in Pain Threshold Values of Masseter and Temporalis Muscles Before and After Mastication

Abstract Objective: To analyze the differences in the pain thresholds of the masseter and temporalis muscles before and after chewing at the 5th and 10th minutes. Material and Methods: In this cross-sectional study, the pain thresholds of the muscles in both sides of 43 non-TMD subjects were measured using a digital algometer before and after chewing the bubble gum Xylitol for 5 and 10 min. The values of the muscles before and after mastication at the 5th and 10th were analyzed using Repeated ANOVA. A difference in the values between the left and right sides of the muscles were analyzed using independent t-test, and among the age groups using one-way ANOVA. Results: Average pain threshold values were 1.76 and 1.93 KgF/cm2 for the masseter and temporalis muscles. ANOVA tests indicated significant differences in the values of the muscles before and after mastication at the 5th and 10th min (p=0.000 vs. p<0.001). The differences in the values between the left and right sides of the muscles (p>0.05) and among the age groups (p>0.05) showed no significant difference. However, the values between temporalis and masseter and the values between men and women for each session revealed a significant difference (p<0.05) Conclusion: The masseter and temporalis pain threshold values were reduced 10 min after chewing. The values in both sides of the masseter and temporalis muscles and in different age groups were the same. The temporal muscle and men showed a higher pain threshold than the masseter muscle and women, respectively.

Restablecimiento de dimensión vertical en paciente con presión retrodiscal / Restoring of Vertical Dimension in a Patient with Retrodiscal Pressure

RESUMEN Cuando realizamos la rehabilitación oral, debemos considerar la importancia de lograr la estabilidad ortopédica al finalizar el tratamiento. Dicha condición depende de la Articulación Temporomandibular y todos los componentes neuroclusomusculares. Para lograrlo es necesario tomar en cuenta diferentes parámetros como son la oclusión en céntrica y la dimensión vertical. Al hacerlo disminuimos la probabilidad de que se presenten diferentes problemas neuroclusomusculares como son Trastornos de la Articulación Temporomandibular, Bruxismo, problemas periodontales, abfracciones, fractura de restauraciones, entre otros.

ABSTRACT When oral rehabilitation is performed, an important consideration is to reach an orthopedic stabilization, at the end of the treatment. This condition depends on the Temporomandibular Joint and all neuroclusomuscular components. To achieve this, it is necessary to take into account different parameters such as centric occlusion and vertical dimension. In doing so, we decrease the likelihood of different neuroclusomuscular problems, such as Temporomandibular Joint Disorders, Bruxism, periodontal problems, abfractions, fracture of restorations, among others.

CBCT analysis of rabbit temporomandibular joints with osteoarthrosis induced by monoiodoacetate and papain / Análisis por TCCB de la articulación temporomandibular de conejos con osteoartrosis inducida por monoiodoacetato y papaina

Osteoarthrosis (OA) is a degenerative disease characterized by loss of joint cartilage, remodelling of the subchondral bone, narrowing of joint spaces and the formation of osteophytes. Animal models are used to study the mechanisms of OA, as well as to test the effects of anti-osteoarthrosis drugs. The objective of the present study was to determine the changes identifiable by imaging techniques occurring in rabbit temporomandibular joints (TMJ) at 15, 25 and 45 days after OA inducement by monoiodoacetate (MIA) and papain. The imaging technology used was cone-beam computerised tomography (CBCT). The model animals were 22 young adult male New Zealand rabbits, divided randomly into three study groups: Four rabbits in the control group, nine in the papain experimental group and nine in the monoiodoacetate (MIA) experimental group. OA was induced by arthrocentesis in the lower compartment of both TMJs. The rabbits were examined by CBCT at 15, 25 and 45 days after the injection of MIA and papain. The mandibular condyles presented loss of their rounded shape, deformation of the condyle or mandibular fossa, cortical irregularity, cortical wear and changes in the dimensions of the condyle. OA induction by MIA and papain generates changes observable by CBCT in the dimensions of the mandibular condyle in rabbits. Both inducers promote signs compatible with OA on the joint surfaces of the TMJ; MIA promotes more expressive changes.

La osteoartrosis (OA) es una enfermedad degenerativa caracterizada por la pérdida de cartílago articular, remodelación ósea subcondral, estrechamiento del espacio articular y formación de osteofitos. El modelo animal es utilizado para estudiar los mecanismos de la OA, así como testar el efecto de drogas anti-osteoartrosis. El objetivo de este estudio fue determinar los cambios imagenológicos, mediante tomografía computarizada cone-beam (TCCB), que se generan en 15, 25 y 45 días, luego de la inducción de OA por medio de Monoiodoacetato (MIA) y Papaína sobre la ATM de conejos. Fueron utilizados 22 conejos machos, adultos jóvenes, de raza New Zealand divididos aleatoriamente en 3 grupos de estudio: 4 conejos para un grupo control, 9 conejos para el grupo experimental con Papaína y 9 conejos para el grupo experimental con monoiodoacetato (MIA). Se realizó la inducción de OA por la técnica de artrocentesis en el compartimiento inferior de ambas ATMs. Se les realizó examen de TCCB en los días 15, 25 y 45 tras la inyección de MIA y de papaina. Los cóndilos mandibulares presentaron pérdida de forma redondeada de cóndilo, deformidad de cóndilo o fosa mandibular, irregularidad de corticales, desgaste de corticales, cambio de dimensiones de cóndilo. La inducción de OA por medio de MIA y papaína genera cambios en la dimensión del cóndilo mandibular de conejos observables a través de TCCB. Además, ambos inductores promueven signos compatibles con OA en las superficies articulares de la ATM, siendo que la MIA promueve cambios más expresivos.

Trastornos temporomandibulares en la infancia: bruxismo de sueño y compromiso de atm en artritis idiopática juvenil / Temporomandibular disorders in childhood: sleep bruxism and temporomandibular joint involvement in juvenile idiopathic arthritis

Los trastornos temporomandibulares (TTM) corresponden a un grupo de condiciones musculoesqueletales y neruromusculares que involucran las articulaciones temporomandibulares (ATM), los músculos masticatorios y todos los tejidos asociados. La etiología de los TTM es considerada multifactorial, siendo el bruxismo de sueño (BS) uno de muchos factores asociados con TTM dolorosos. Tanto los TTM como el BS se presentan en adultos y niños y actualmente es sabido que la etiopatogenia de ambos no difiere de acuerdo a la edad. Las ATM son articulaciones sinoviales que pueden verse afectadas por diversos TTM o por condiciones sistémicas como la artritis idiopática juvenil (AIJ). La ATM está involucrada en un 40% de los pacientes con AIJ, siendo subestimada debido a que clínica-mente se manifiesta con poco dolor. En el presente artículo se revisarán los conceptos de TTM y BS en niños, así como también la manifestación de la AIJ en el territorio orofacial, entregando una aproximación de su etiopatogenia, identificación y manejo.

Temporomandibular disorders (TMD) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJ), the masticatory muscles, and all associated tissues. TMD's etiology is considered to be mul-tifactorial, were sleep bruxism (SB) is one of many causes of painful TMD. TMD and SB can present in adults and children and the etiology does not differ regarding age.TMJ are synovial joints that can be affected by many TMD as well as systemic conditions such as juvenile idiopathic arthritis (JIA). TMJ are involved in 40% of patients with JIA, which is usually underestimated because of its painless presentation.This article will review the concepts of TMD and SB in children, as well as JIA presentation in the orofacial region.

Short term histopathological effects of GaAlAs laser on experimentally induced TMJ osteoarthritis in rabbits

Abstract The aim of this study was to evaluate the biostimulation (BS) effect of the gallium-aluminum-arsenide (GaAlAs) diode laser by histopathology with an experimental osteoarthritis (OA) model in the temporomandibular joints (TMJ) of rabbits, in the early period. GaAlAs diode laser is used for pain reduction in TMJ disorders. Twenty-four adult male New Zealand white rabbits were randomly divided into three equal groups: Control Group (CG), Study Group 1 (SG-1), and Study Group 2 (SG-2). Mono-iodoacetate (MIA) was administered to the right TMJs of all rabbits. The rabbits did not undergo any treatment for four weeks to allow the development of osteoarthritis. In SG-1, laser BS was applied to the rabbits at 940 nm, 5 W, and 15 J/cm2 in continuous wave mode at 48-hour intervals for 14 sessions; and in SG-2, laser BS was applied with the same parameters at 24-hour intervals for 28 sessions. Laser BS was not applied to the rabbits in CG. All rabbits were sacrificed simultaneously. The TMJ cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification were evaluated histopathologically. There was no statistically significant difference between the groups in terms of cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification values (p > 0.05). The laser BS protocol used in the study had no positive histopathological effects on TMJ OA in the early period.

Association between ADAMTS14 gene polymorphism and the temporomandibular joint osteoarthritis in Chinese Han females / 北京大学学报(医学版)

OBJECTIVE@#To investigate the association between single nucleotide polymorphisms (SNP) of ADAMTS14 gene rs4747096 and osteoarthritis of the temporomandibular joint in Chinese Han females.@*METHODS@#As a case-control study, a total of 213 Chinese Han females were involved in the present study, which contained 103 temporomandibular joint osteoarthritis patients and 110 healthy people who had no symptoms or signs of temporomandibular joint osteoarthritis as control. Peripheral blood samples were collected from each participant. Genomic DNAs of temporomandibular joint osteoarthritis patients and healthy control were extracted from peripheral venous blood, which were stored in -80 °C refrigerator by using DNA extraction kits. The designed primers were used for polymerase chain reaction (PCR) amplification of specific DNA fragments. Genotype was determined by sequencing the PCR products. The software Chromas 2.22 was used to analyze the genotype. The genotype distributions, allele frequencies and genetic models between the patients and controls were compared. The age distribution was checked by t-test. Genotype and allele frequency were detected by Chi-square test.@*RESULTS@#In the present study, there were no significant differences between the osteoarthritis patients and healthy controls in terms of age. The genotype distribution was in accordance with Hardy-Weinberg equilibrium in the two groups. The genotype frequency of the ADAMTS14 (rs4747096) in the experimental group was 38.8% (AA), 55.4% (AG), and 5.8% (GG), respectively. The genotype frequency in the control group was 40.9% (AA), 43.6% (AG), and 15.5% (GG), respectively. The difference of genotype frequency of the ADAMTS14 (rs4747096) was significant between the experimental group and the control group (P=0.047). There was no significant difference in allele frequency between the two groups (P=0.415). AA and AG genotypes significantly increased the risk of the disease compared with GG in dominant model (OR=1.114, 95% CI: 1.015-1.223, P=0.028).@*CONCLUSION@#A significant correlationship was found between the ADAMTS14 (rs4747096) SNP and the temporomandibular joint osteoarthritis in Chinese Han females. The distribution of rs4747096 may be different between temporomandibular joint osteoarthritis and healthy population.

Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report

Abstract Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Resumo Tumor de células gigantes tenossinovial do tipo difuso (TCGT-d) ou sinovite vilonodular pigmentada (SVP) é uma lesão localmente agressiva que afeta principalmente as articulações dos ossos longos. Tumor de células gigantes tenossinovial condroide (TCGTC) ou SVP com metaplasia condroide é um tipo distinto e raro de tumor sinovial que tem a predileção pela articulação temporomandibular (ATM). Nós relatamos um caso raro de TCGTC da ATM, inicialmente diagnosticado, equivocadamente, como disfunção temporomandibular (DTM). Uma mulher de 51 anos foi encaminhada ao cirurgião com a queixa principal de dor na ATM por 5 anos, e uma história de tratamento de DTM sem sucesso. O exame extrabucal revelou discreto aumento de volume preauricular e movimentação mandibular restrita. A radiografia panorâmica e a tomografia computadorizada evidenciaram destruição da fossa mandibular e côndilo. Histologicamente, o tumor era composto por células mononucleares grandes, com amplo citoplasma eosinofílico e núcleo sulcado, pequenas células histiocitoides, células multinucleadas semelhantes a osteoclastos, pigmentação acastanhada e áreas de metaplasia condroide. As características morfológicas e imuno-histoquímicas levaram ao diagnóstico final de TCGTC. A raridade desta lesão pode estar associada ao seu não reconhecimento, sendo casos diagnosticados como condroblastoma, condromatose sinovial ou condrossarcoma. A paciente recebeu reconstrução imediata e recorrência foi observada 22 meses após a intervenção inicial. TCGT-d e TCGTC da ATM podem apresentar sintomas similares à DTM, mas os clínicos devem diferenciar ambas as lesões por meio do exame clínico completo, exames de imagem e, quando necessário, avaliação histopatológica.

Anquilose da articulação temporomandibular na infância: análise da expressão gênica da osteoprotegerina e do ligante do fator ativador do receptor nuclear kappa-b / Temporomandibular joint ankylosis in childhood: analysis of osteoprotein gene expression and kappa-b nuclear receptor activator factor ligand

A anquilose da articulação temporomandibular (AATM) apesar de rara, é uma doença grave e de difícil tratamento, que restringe os movimentos articulares acarretando ao paciente problemas estéticos, nutricionais, psicológicos e sociais. A formação do bloco ósseo anquilótico determina a gravidade da doença. O remodelamento ósseo é um mecanismo coordenado e extremamente complexo responsável pela formação e pela reabsorção óssea, sendo necessário no reparo de trauma ósseo e na manutenção da homeostasia do metabolismo mineral. Assim, entender o processo de remodelamento ósseo envolvido na fisiopatologia das AATMs pode trazer perspectivas no tratamento desta doença. O objetivo do estudo foi avaliar o perfil de expressão dos genes envolvidos no remodelamento ósseo, osteoprotegerina (OPG) e do fator ativador do receptor nuclear kappa-B/ligante (RANKL), em amostras de crianças com AATM para verificar se existe associação com a degeneração articular da ATM. Foram incluídos no estudo 11 crianças com diagnóstico de AATM e 5 amostras de osso controle (sem alteração patológica na ATM). A idade média dos pacientes com AATM foi de 12 anos, sendo que 9 (82%) já haviam realizado cirurgia prévia de AATM, 36% (n = 4) apresentaram otite em fase neonatal e 18% (n = 2) infecção prévia. A expressão de OPG e RANKL foi avaliada pela reação em cadeia da polimerase quantitativa. Foi observado uma menor expressão de OPG e RANKL nas amostras de pacientes com AATM (bloco anquilótico e osso adjacente à anquilose) comparado as amostras controle. O RANKL e OPG regulam a reabsorção óssea por estimulação do RANK em células precursoras de osteoclastos. Nossos resultados são corroborados por um estudo recente, justificando a investigação da via RANK-RANKL-OPG na AATM, com o intuito de se explorar novas possibilidades terapêuticas, que possam auxiliar no tratamento desta doença que ainda é negligenciada. A menor expressão de OPG e RANKL indicam que a patogênese da AATM em crianças está relacionada a diminuição da reabsorção óssea.

Temporomandibular joint ankylosis (TMJA), although rare, is a serious and difficult to treat disease, which restricts joint movements, causing aesthetic, nutritional, psychological and social problems to the patient. The formation of the ankylotic bone block determines the severity of the disease. Bone remodeling is a coordinated and extremely complex mechanism responsible for bone formation and resorption, and is necessary for the repair of bone trauma and the maintenance of homeostasis of mineral metabolism. Thus, understanding the process of bone remodeling involved in the pathophysiology of TMJA may bring perspectives in the treatment of this disease. The aim of the study was to evaluate the expression profile of the genes involved in bone remodeling, osteoprotegerin (OPG) and nuclear kappa-B receptor activator / RANKL (RANKL) in samples from children with TMJA to verify if there is association with Joint degeneration of TMJ. The study included 11 children with TMJA diagnosis and 5 control bone samples (without pathological alterations in TMJ). The mean age of patients with TMJA was 12 years, and 9 (82%) had previously performed TMJA surgery, 36% (n = 4) presented otitis in the neonatal phase and 18% (n = 2) had previous infection. The expression of OPG and RANKL was evaluated by the quantitative polymerase chain reaction. Lower expression of OPG and RANKL was observed in the samples of patients with TMJA (ankylotic block and bone adjacent to ankylosis) compared to the control samples. RANKL and OPG regulate bone resorption by stimulating RANK in osteoclast precursor cells. Our results are corroborated by a recent study, justifying the investigation of the RANK-RANKL-OPG pathway in the TMJA, in order to explore new therapeutic possibilities that may help in the treatment of this disease that is still neglected. Lower expression of OPG and RANKL indicate that pathogenesis of TMJA in children is related with lower bone resorption.

Relationship between articular eminence inclination and alterations of the mandibular condyle: a CBCT study

Abstract This study aimed at verifying the correlation among angulation of the articular eminence (AE), shape of the condyle and its degenerative bone diseases (DBDs), according to age and sex, through Cone Beam Computed Tomography (CBCT). Five hundred and twenty-eight temporomandibular joints (TMJ) were evaluated. The condyles were classified as: flat, convex, angled and rounded, and the AE angulation was measured. The DBDs evaluated were osteophytes, flattening, erosion, subcortical cysts and spinal sclerosis. There was no difference in the mean angulations in relation to age group (p>0.05). In age groups of 60-69 years (p=0.003) and 70 years or over (p=0.021), the angulation was higher in males. There was an association between DBD and sex (p=0.047), in that the prevalence was higher in females. Differences in AE angles were not observed in condyles with one or no DBDs (p>0.05). However, the presence of two or more DBDs led to a decrease in the angle (p<0.05). Angled condyles showed higher AE angulations than the flat and convex types (p<0.01). In conclusion, the AE inclination is influenced by DBD and condyle shape; an association of two or more bone diseases in the condyle, or its flat or convex anatomy, results in a decrease in the angulation.

Tomographic evaluation of the temporomandibular joint in malocclusion subjects: condylar morphology and position

Abstract The aim of this study was to investigate condyle concentricity and morphology, and their association with Class I and II malocclusions (Angle). The sample consisted of 49 individuals of both genders, between 11 and 35 years old, divided into two groups, G1: 26 patients with Class I malocclusion, and G2: 23 patients with Class II malocclusion, selected for orthodontic treatment. Evaluation of the condyle morphology and position was performed by the same previously calibrated examiner using cone-beam computed tomography (CBCT) images of the subjects. The CBCT scans were analyzed by means of a 3D program (Dolphin 11.5, Dolphin Imaging & Management Solutions, Chatsworth, CA, USA), with a 25% level of sensitivity. The images obtained from the coronal slices were employed for the condyle morphology analysis, which classified the condyle form as rounded, as flat or convex, and as triangular or angled. The sagittal slices were used to classify further the condyles as concentric and displaced anteriorly or posteriorly. A clinical examination was also performed, including TMJ and muscle palpation. The kappa test was used to evaluate investigator calibration; the Chi-square and paired t-tests were used for analysis. The convex and anteriorly positioned condyles were found most frequently, regardless of the type of malocclusion. No association was observed between the groups regarding condylar characteristics.

Efeitos do hiperboloide masticator apparatus na desordem temporomandibular ­ estudo de caso / Effects of hyperboloid masticator apparatus in temporomandibular disorder ­ case study

Introdução: A disfunção temporomandibular caracteriza-se por um conjunto de alterações clínicas envolvendo os músculos mastigatórios, a articulação temporomandibular e outras estruturas associadas. Objetivo: A estimulação proprioceptiva condicionada pelo uso do hiperboloide diminui o quadro álgico e aumenta a amplitude do movimento mandibular. Métodos: Apresentamos o caso de uma jovem de 22 anos com diagnostico de Disfunção temporomandibular, que recebeu o tratamento fisioterapêutico utilizando hiperboloide mastigador apparatus 3 vezes por semana durante 8 semanas sendo realizadas duas avaliações específicas: extensão vertical do movimento mandibular e mensuração do limiar de dor por pressão sobre o músculo masseter, pré atendimento, pós imediato e pós tratamento. Resultados: Observou-se aumento expressivo na abertura mandibular e no aumento de limiar de dor. Conclusão: O uso do hiperboloide levou a um aumento mobilidade mandibular e diminuição de dores nos músculos masseteres e consequente melhora na mastigação.

Introduction: temporomandibular dysfunction is characterized by a set of clinical changes involving the masticatory muscles, the temporomandibular joint and other associated structures. Goal: proprioceptive stimulation conditioned by the use of the hyperboloid influences on pain and mandibular movement pattern. Methods: we present the case of a young man of 22 years with diagnosis of temporomandibular joint Dysfunction, which received physiotherapy treatment using hyperboloid Cruncher apparatus 3 times per week for 8 weeks being held two specific reviews: vertical extension of the mandibular movement and measurement of pressure pain threshold on the masseter muscle, pre care, immediate post and post treatment. Results: it was observed significant increase in mandibular opening and increased pain threshold. Conclusion: the use of hyperboloid has led to an increase in mandibular mobility and decrease of myalgia masseteres and consequent improvement in chewing.

Problemas autoinmunes como factor etiológico de las alteraciones del desarrollo de la mandíbula: artritis reumatoidea juvenil / Autoimmune problems as etiolocial factors of developmental disorders of the jaw: juvenile idiopathic arthritis

La artritis reumatoidea juvenil (ARJ) es una enfermedad inflamatoria autoinmune en niños menores de 16 años. Es de curso crónico, etiología desconocida y afecta sobre todo las articulaciones, como la temporomandibular (ATM). El compromiso de la ATM puede ocasionar alteraciones en el crecimiento facial (micrognatia), maloclusión clase II, mordida abierta anterior, desviaciones laterales, erosiones óseas, destrucción del cóndilo, oclusión disfuncional y alteración de la estética facial, entre otras consecuencias. La posición oclusal neurofisiológica lograda por medio de elementos electrónicos, como el Transcutaneous Electrical Neural Stimulation (TENS), y mantenida por el dispositivo intraoral (DIO), posibilitaría la remodelación de la cabeza del cóndilo, en pacientes en crecimiento, en los que la enfermedad se halla controlada, controlando así también la sintomatología dolorosa.