Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis / 华西口腔医学杂志

OBJECTIVES@#The aim of this study was to compare the anterior and posterior occlusal plane characteristics of patients with different temporomandibular joint osseous statuses.@*METHODS@#A total of 306 patients with initial cone beam CT (CBCT) and cephalograms were included. They were divided into three groups on the basis of their temporomandibular joint osseous status: bilateral normal (BN) group, indeterminate for osteoarthrosis (I) group, and osteoarthrosis (OA) group. The anterior and posterior occlusal planes (AOP and POP) of the different groups were compared. Then, the regression equation was established after adjusting for confounding factors, and a correlation analysis between the occlusion planes and other parameters was performed.@*RESULTS@#SNA, SNB, FMA, SN-MP, Ar-Go, and S-Go were correlated with the occlusal planes. Relative to the BN and I groups, the FH-OP of the OA group increased by 1.67° on the average, FH-POP increased by 1.42° on the average, and FH-AOP increased by 2.05° on the average.@*CONCLUSIONS@#The occlusal planes were steeper in the patients with temporomandibular osteoarthrosis than in the patients without it, and the mandible rotated downward and backward. The height of the mandibular ramus, the mandibular body length, and the posterior face height were small. In clinical practice, attention should be given to the potential risk of temporomandibular joint osteoarthrosis in such patients. In addition, SNB, FMA, SN-MP, Ar-Go, S-Go, and occlusal planes had moderate correlations.

Evolution of mirror-image pain in temporomandibular joint osteoarthritis mouse model

Abstract Mirror-image pain is a kind of pain that occurs on the contralateral side, but its pathogenesis remains unclear. Objective To develop an osteoarthritis mouse model for investigating mirror-image pain through observing nocifensive behaviors, histological changes, and nociceptive activity at days 3, 7, 14, 21, and 28 after the chemical induction of unilateral temporomandibular joint (TMJ) osteoarthritis. Methodology We randomly divided 6-week-old mice into sham and complete Freund adjuvant groups. To induce nocifensive behaviors, we applied 0.04 g of von Frey filament, 10 psi of air puff, and cold acetone on both sides of whisker pads at different days. The histology of TMJ on both sides was observed by hematoxylin/eosin staining and microcomputed tomography scanning. Furthermore, the nociceptive activity was evaluated using the phosphorylated cyclic AMP response element binding protein (pCREB) and a microglia marker at different days in the trigeminal subnucleus caudalis. Results Nocifensive behaviors against mechanical and temperature stimuli on the contralateral side became stronger than the baseline on day 28, in agreement with the elevation of the pCREB and the microglia marker in the trigeminal subnucleus caudalis. Thus, hypernociception on the contralateral side occurred at day 28. Conclusions Clearly, the TMJ model with unilateral osteoarthritis exhibited mirror-image pain. Therefore, this model is useful in investigating the pathogenesis of pain and in developing treatments.

Métodos de diagnóstico y tratamiento actuales de la osteoartritis de la articulación temporomandibular: una revisión de la literatura / Current diagnostic methods and treatment of tmporomandibular joint osteoarthritis: a review of the literature

Este artículo involucra una revisión de los factores etiológicos asociados a la osteoartritis (OA) de la articulación temporomandibular (ATM), así como los hallazgos imagenológicos, los cuales son indispensables para el diagnóstico y la determinación de la etapa de evolución de esta patología. Además, se discuten los métodos de tratamiento invasivos y no invasivos. Los objetivos del presente artículo fueron describir los métodos de diagnóstico y tratamiento más actuales y eficientes para la osteoartritis de la articulación temporomandibular, y determinar la existencia de la correlación clínica e imagenológica en las diferentes etapas de esta patología. A partir de una revisión de la literatura, se encontró que el método de diagnóstico más relevante para la OA de la ATM es la tomografía computarizada de haz cónico (TCHC), por sus múltiples ventajas. El método de tratamiento más eficiente durante la etapa sintomatológica de la enfermedad es la artrocentesis sinergizada con ácido hialurónico o plasma rico en plaquetas. Cabe resaltar que no se encontraron correlaciones directas suficientes entre los cambios óseos y la sintomatología clínica de la OA de ATM empleando la TCHC. (AU)

The objectives of this article were to describe the most current and efficient diagnostic and treatment methods for osteoarthritis of the temporomandibular joint (TMJ) and to determine the correlation of clinical and imaging in the different stages of this pathology. We review the etiological factors associated with osteoarthritis (OA) of the TMJ as well as the imaging findings, which are essential for the diagnosis and determination of the stage of evolution of this pathology. In addition, invasive and noninvasive treatment methods are discussed. Based on review of the literature, the most relevant diagnostic method for OA of the TMJ is conic beam computed tomography (CBCT), due to its multiple advantages. The most efficient treatment method during the symptomatic stage of the disease is arthrocentesis synergized with hyaluronic acid or plateletrich plasma. It was of note that no direct correlation was found between bone changes and the clinical symptomatology of TMJ OA using CBCT. (AU)

Prevalencia y distribución de signos degenerativos en cóndilo de la ATM presentes en radiografías panorámicas en población chilena / Prevalence and distribution of degenerative signs in ATM condyle in panoramic radiographs in a Chilean population

La articulación temporomandibular (ATM), como todas las articulaciones, es afectada por enfermedades inflamatorias o degenerativas, traumatismos, malformaciones, infecciones, quistes y tumores. La artrosis u osteoartrosis (OA) es la enfermedad degenerativa más frecuente de las articulaciones del cuerpo humano, incluyendo la ATM. El propósito de este estudio fue determinar la prevalencia de signos imagenológicos de trastornos degenerativos en el proceso condilar de la ATM, presentes en radiografías panorámicas digitales (RPD) de población chilena. Para ello se realizó un estudio de corte transversal que utilizó 651 radiografías de individuos adultos, en las que se buscó la presencia de los siguientes signos imagenológicos de osteoartrosis: esclerosis, pérdida de la cortical, erosión, osteofitos y quistes endocondrales. La prevalencia de signos radiográficos de OA fue de un 35 % (n=230); donde el 50 % de los individuos con signos de OA fueron mayores de 50 años, mientras la diferencia se distribuyó de forma homogénea en los distintos rangos etáreos. El signo más prevalente fue el osteofito (25 %) y la pérdida de cortical fue la menos observada (3 %). Además, la esclerosis presentó una prevalencia del 6 %, la erosión del 4 % y los quistes endocondrales del 6 %. Por su parte la frecuencia de signos observada en hombres fue mayor, detectándose un aumento en relación directa con la edad independiente del sexo. La radiografía panorámica por su accesibilidad, baja dosis de radiación y constituir un examen de rutina, constituye un medio apropiado para pesquizar hallazgos de signos degenerativos de la ATM.

The temporomandibular joint (TMJ), like all joints, is affected by inflammatory or degenerative diseases, traumatisms, malformations, infections, cysts and tumors. Osteoarthrosis (OA) is the most common degenerative disease of the joints of the human body, including the temporomandibular joint. The purpose of this study was to estimate the prevalence of imaging signs of degenerative disorders in the TMJ condyle, present in digital panoramic radiographs in Chilean population. A cross-sectional study was conducted using 651 radiographs of adult individuals. The presence of the following imaging signs of osteoarthrosis was recorded: sclerosis, cortical loss, erosion, osteophytes and endochondral cysts. The prevalence of radiographic signs of OA was 35 % (n = 230); where 50 % of the individuals with signs of OA were older than 50 years, while the difference was distributed homogeneously in the different age ranges. The most prevalent sign was osteophyte (25 %) and cortical loss was the least observed (3 %). In addition, sclerosis presented a prevalence of 6 %, erosion of 4 % and endochondral cysts of 6 %. On the other hand, the frequency of signs observed in men was greater, detecting an increase in direct relation with age independent of sex. The data of this study allows us to conclude that the prevalence of OA in the studied population was 35 % with a higher representation in men and older people. Both the value of the prevalence of OA and that corresponding to each sign are affected by the modality of radiographic analysis and methodological considerations.

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.

3-D structural changes in subchondral bone and the effect of bisphosphonate intervention in early osteoarthritis / Cambios estructurales tridimensionales del hueso subcondral y el efecto de la intevención con bisfosfonato en la osteoartritis temprana

This study aims to observe the 3-D structural changes in subchondral bone and the effects of bisphosphonate intervention in the early unsteady stage of the knee joint. Sixty healthy male New Zealand white rabbits were divided into the model group (n= 24), the bisphosphonate (Bis) group (n= 24), and the control group (n= 12). The rabbits' right knees were used to evaluate the structural changes. The Bis group received subcutaneous injections of bisphosphonate, while the model and control groups received subcutaneous injections of isotonic saline solution. After surgical preparation, the knee joint was dissected for Micro-CT examination, and the Micro-CT results were compared using ANOVA. In the fourth postoperative week, the bone volume fraction (BVF), trabecular number (Tb.N), and trabecular thickness (Tb.Th) of the model group were significantly lower than those of the control group (P<0.01). There was no significant difference between the Bis and control groups. In the twelfth postoperative week, BVF, Tb.Th, and Tb.N of the model group were significantly higher than those of the control and Bis groups (P <0.05). Similarly, bone mineral density was higher in the model group (P <0.01), while the trabecular spacing was significantly lower (P <0.05). In the early unsteady stage of the knee joint, the subchondral bone had markedly decreased, while obvious bone formation was visible in the late stage. Bisphosphonates could protect the subchondral bone structure by inhibiting bone absorption.

El objetivo fue observar los cambios estructurales en 3-D del hueso subcondral y los efectos de la intervención con bifosfonatos en la etapa temprana de la inestabilidad de la articulación de la rodilla. Sesenta conejos blancos New Zealand machos sanos se dividieron en tres grupos: modelo (n= 24), bisfosfonato (Bis) (n= 24) y control (n= 12). Las rodillas derechas de los conejos se utilizaron para evaluar los cambios estructurales. El grupo Bis recibió inyecciones subcutáneas de bisfosfonato, mientras que los grupos modelo y control recibieron inyecciones subcutáneas de solución salina isotónica. Después de la preparación quirúrgica, la articulación de la rodilla fue disecada para su análisis mediante micro-TC, y los resultados se compararon mediante ANOVA. En la cuarta semana postoperatoria, la fracción del volumen óseo (GVF), el número trabecular (Tb.N) y el espesor trabecular (Tb.Th) del grupo modelo fueron significativamente más bajos que los del grupo control (P <0,01). No hubo diferencia significativa entre los grupos control y Bis. En la semana 12 postoperatoria, BVF, Tb.Th, y Tb.N del grupo modelo fueron significativamente mayores que los del grupo control y Bis (P <0,05). Del mismo modo, la densidad mineral ósea fue mayor en el grupo modelo (P <0,01), mientras que la separación trabecular fue significativamente menor (<0,05 P). En la etapa inestable temprana de la articulación de la rodilla, el hueso subcondral disminuyó notablemente, mientras que la formación ósea obvia fue visible en la etapa tardía. Los bisfosfonatos podrían proteger la estructura ósea subcondral mediante la inhibición de la absorción ósea.

Value of Ultrasound in Rheumatologic Diseases

The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.

Hand osteoarthritis: clinical and imaging study

To examine the validity of US in assessing hand osteoarthritis [OA] and to study the relationship between ultrasonographic findings and OA symptoms. This study was carried out on thirty patients with primary hand OA, and fifteen healthy subjects serving as a control group. Patients were classified according to ultrasonographic findings of joint involvement into two subgroups: 15 patients with interphalangeal [IP] OA and 15 patients with IP and first carpometacarpal [CMC] joint OA. All hand joints were examined for tenderness, soft tissue swelling, hard tissue enlargement [nodes], and deformity. Functional assessment by AUSCAN questionnaire, grip and pinch strength measurement and pain assessment by Visual Analogue Scale [VAS] were carried out. Plain X-rays of both hands were taken and classified according to the Kellgren-Lawrence [K-L] grading scale. High resolution US of the hand joints was performed which focused on examining cartilage thinning, joint space narrowing [JSN], and osteophytes [OST]. There was a positive correlation between the K-L grading and US findings regarding JSN and OST. There was a positive correlation of AUSCAN score with cartilage thinning, OST and JSN. There was a negative correlation of grip strength with cartilage thinning and OST. There was a negative correlation between pinch strength and US findings [cartilage thinning, OST and JSN]. There was a positive correlation between pain and US findings. Heberden's nodes were associated with underlying distal IP cartilage thinning, OST and JSN. On comparing the two subgroups of patients; patients with both IP and first CMC joint involvement experienced significantly higher levels of pain and disability and had weaker pinch strength. Ultrasonographic findings correlated with clinical findings as nodes, functional parameters as grip and pinch strength, and pain. The increased detection of OA structural pathology by US may make this a useful tool for hand OA assessment

Treatment of Isolated Ankle Osteoarthritis with Arthrodesis or the Total Ankle Replacement: A Comparison of Early Outcomes

BACKGROUND: Ankle arthrodesis and replacement are two common surgical treatment options for end-stage ankle osteoarthritis. However, the relative value of these alternative procedures is not well defined. This study compared the clinical and radiographic outcomes as well as the early perioperative complications of the two procedures. METHODS: Between January 2, 1998 and May 31, 2002, 138 patients were treated with ankle fusion or replacements. Seventy one patients had isolated posttraumatic or primary ankle arthritis. However, patients with inflammatory arthritis, neuropathic arthritis, concomitant hind foot fusion, revision procedures and two component system ankle replacement were excluded. Among them, one group of 42 patients had a total ankle replacement (TAR), whereas the other group of 29 patients underwent ankle fusion. A complete follow-up could be performed on 89% (37/42) and 73% (23/29) of the TAR and ankle fusion group, respectively. The mean follow-up period was 4.2 years (range, 2.2 to 5.9 years). RESULTS: The outcomes of both groups were compared using a student's t-test. Only the short form heath survery mental component summary score and Ankle Osteoarthritis Scale pain scale showed significantly better outcomes in the TAR group (p < 0.05). In the radiographic evaluation, there was no significant difference in preoperative and postoperative osteoarthritis between the TAR and fusion groups. CONCLUSIONS: The clinical results of TAR are similar to those of fusion at an average follow-up of 4 years. However, the arthroplasty group showed better pain relief and more postoperative complications that required surgery.

Evolución clínica y radiográfica de una artrosis de mano en veinticinco años / Clinical and radiographic hand osteoarthritis in twenty five years

Se presenta la evolución clínica y radiográfica de una artrosis de mano seguida durante 25 años. Se hace énfasis en los buenos resultados obtenidos con un nuevo programa de ejercicios. Se analizan detalladamente losproblemas de alineación e inestabilidad del carpo y su colapso, tanto en las radiografías simples como en la escanografía.

Oncostatin-M and matrix metalloproteinase-3 production in rheumatoid arthritis and osteoarthritis

To evaluate the significance of measuring serum levels of Oncostatin-M [OS-M] and matrix metalloproteinase-3 [MMP-3] in the assessment of rheumatoid arthritis [RA] and osteoarthritis [OA]. The study was performed on 15 RA, 15 OA patients and 10 controls age and sex matched. Laboratory and clinical data for all the patients were assessed and serum MMP-3 and OS-M were measured in all subjects. Statistical analysis and correlations were done for all the data. Serum levels of MMP-3 and OS-M were higher in RA than OA patients and controls. The difference was of a high statistical significance [p<0.001, p<0.001]. In RA patients OS-M level correlated positively with MMP-3 level [r=0.826] but OS-M and MMP-3 did not correlate with any parameters of disease activity. There was a significant difference in serum levels of OS-M and MMP-3 in patients taking steroid therapy and those who were not on steroid therapy. In OA patients, serum MMP-3 and OS-M were also higher than those of controls and the difference was highly significant. MMP-3 in OA patients correlated positively with ESR [r=0.77] and this was higher in patients with severe erosive changes. Measuring serum MMP-3 and OS-M is necessary for evaluating synovial inflammation and cartilage destruction in RA and OA patients. Using MMP inhibitor may be useful to stop the progression of synovitis and erosions

Erosive inflammatory osteoarthritis, clinical and radiological study, in comparison with nodal idiopathic osteoarthritis

The aim of this work was to verify the nature and etiology of EOA both clinically and radiologically in comparison with idiopathic nodal OA. 25 patients diagnosed as having hand joints inflammatory erosive arthritis [pain, stiffness and swelling of the joints of both hands] were studied. Erosions in EOA may simply be an aggressive form of joint destruction in joint which is already of risk. The pattern of involvement in this model is determined by incompletely understood factors. Clinical syndrome of EOA can occur in the absence of radiographically demonstrable bony erosions, therefore the term erosive osteoarthritis is not an ideal one for this disorder

Role of arthrography in non-traumatic painful wrist.

The arthrographic examination was carried out in 25 patients with non-traumatic painful wrist of more than 6 weeks duration. Plain x-rays were non-contributory in making any diagnosis in 20 cases. Arthrography was performed even when plain x-rays were normal and it revealed the soft tissue abnormalities and early phases of cartilage destruction not visible on routine roentgenograms. The extent of synovial involvement demonstrated on arthrography proved useful when synovectomy was planned. After operation pain and swelling disappeared and functions of the joint improved considerably.

Radiological grading of knee osteoarthritis: a comparative study

Radiographic examination plays an important role in diagnosis and assessment of osteoarthritis; in this respect, plain radiography remains the standard method despite the introduction of modern imaging techniques. There are still no undisputable criteria for this purpose; many sets have been proposed. The suggested [scoring method] seems to provide a valuable alternative with comparable efficacy, better discrimination of the degenerative changes with minimal inter-observer error

inadequately supported occlusion inductive of TMJ osteoarthritis

Two groups of female patients were selected in this study being affected by TMJ osteoarthritis. The patients of the first group had an inadequately supported occlusion i.e. three or more functional molars were missing, improperly restored or badly decayed. The patients in the second group had an adequately supported occlusion. Clinical and radiographic surveys were carried out. It has been found that the incidence of both the clinical and radiographic findings was higher in the first group. For this group the occlusion has been restored by properly constructed partial dentures. Six months after restoration of occlusion the patients were reexamined. Most of the clinical findings have been imporved especially the crepitation and painful symptoms. The radiographic findings have shown no significant improvement except for restoration of the joint space. It could be concluded that the inadequately supported occlusion might be a cause of TMJ osteoarthritis, and that its restoration to a functional form preserve the joint in its normal relation and function avoiding the excessive load that may resuIt in its degeneration