Comparative study of osteoarthritis induced by monoiodoacetate and papain in rabbit temporomandibular joints: macroscopic and microscopic analysis.

BACKGROUND: Osteoarthritis (OA) is a chronic, progressive, degenerative pathology. Inducing OA in an animal model is useful for studying the pathology and testing the effectiveness of new treatments. The object of the present study was to determine the macroscopic and microscopic changes occurring in rabbit temporomandibular joints (TMJ) at 15, 30 and 45 days after induction of OA by monoiodoacetate (MIA) and papain. MATERIALS AND METHODS: Twenty two male rabbits were used in the experiment, divided into three groups: a control group (n = 4) and two experimental groups, MIA (n = 9) and papain (n = 9). The progress of the disease was analysed at 15, 30 and 45 days after induction of OA. Morphological and histological analyses were carried out of the joint disc and the mandibular condyle. RESULTS: The most evident changes were expressed in the condyle and disc of joints with OA induced by MIA. The condyles presented deformation, fissures and loss of joint surface, the chondrocytes lost their morphology and organisation. In more advanced stages there was loss of the mid zone of the joint disc. CONCLUSIONS: The effects of papain were associated with condyle deformation, disorientation of the chondrocytes in the middle layer, and proliferation in deep zones; there was also an increase in the extracellular matrix. Both inductors generated changes in the TMJ and its joint surfaces; MIA was more effective and coincided more closely with the classic signs of the evolution of OA.

Sex prediction from metrical analysis of macerated mandibles of Brazilian adults / Predicción sexual mediante análisis métrica de mandíbulas maceradas de brasileños adultos

Determining sex may be more difficult in cases such as natural disasters, accidents or situations in which bodies are subjected to high temperatures, when individuals must be identified from their remains. The mandible is a very strong bone, presents high sexual dimorphism and may be useful in forensic identification. The object of the present study was to determine sex by metrical analysis of macerated mandibles of Brazilian adults. We analysed 113 fully dentate macerated mandibles of Brazilian adults, 47 belonging to women and 66 to men. We took 8 measurements using a digital calliper: bicondilar breadth (BC), bigonial breadth (BG), bimental foramina breadth (BM), distance between mental foramen and mandibular base (MF-MB), mandibular ramus height (MRH), maximum mandibular ramus breadth (MaRB), minimum mandibular ramus breadth (MiRB) and mandibular body length (MBL). The t test was used for statistical analysis of independent samples, and a ROC curve was constructed. Direct and stepwise discriminant analysis was carried out. SPSS v.22 software was used, with a significance threshold of 5 %. We observed that all the measurements presented statistically significant differences between the sexes, with greater mean values for men than for women. BG was the measurement which presented the greatest area under curve (AUC), and the highest correct prediction, followed by MRH and BC. The BM distance presented the smallest AUC and lowest correct prediction. The mean correct prediction was 85 % for direct discriminant analysis and 83.2 % for stepwise discriminant analysis, using the BG and MRH measurements. The measurements analysed in this study can be used to determine the sex of Brazilian individuals.

En casos de desastres naturales, catástrofes o situaciones en las cuales los cuerpos son sometidos a altas temperaturas la identificación sexual queda más difícil, siendo necesaria la identificación de los individuos a partir de restos mortales. La mandíbula es un hueso muy resistente, que presenta gran dimorfismo sexual, pudiendo ser útil en la identificación forense. El objetivo de este estudio fue determinar la predicción sexual mediante el análisis métrico de mandíbulas maceradas de individuos brasileños adultos. Fueron analizadas 113 mandíbulas maceradas completamente dentadas de Brasileños adultos, siendo 47 mujeres y 66 hombres. Con un cáliper digital fueron evaluadas 8 medidas: amplitud bi-condilar (BC), amplitud bi-gonial (BG), amplitud entre forámenes mentonianos (BM), distancia entre el foramen mentoniano y la base de la mandíbula (MF-MB), altura de la rama mandibular (MRH), anchura máxima de la rama mandibular (MaRB), anchura mínima de la rama mandibular (MiRB) y longitud del cuerpo de la mandíbula (MBL). Para análisis estadístico se utilizó la prueba t para muestras independientes. Además se construyó una curva ROC. Se realizó análisis discriminante directo y por pasos. Se utilizó el software SPSS V.22, considerando umbral de significación de 5 %. Se observó que todas las medidas presentaron diferencias estadísticas entre sexos, siendo los valores medios encontrados para hombres mayores que los encontrados para mujeres. La BG fue la medida que presentó mayor área bajo la curva (AUC) y mayor predicción, seguido de la MRH y de la BC. La distancia BM fue la medida que presentó la menor AUC y menor predicción. La correcta predicción para el análisis discriminante directo alcanzó el 85 % y por pasos alcanzó el 83.2 % utilizándose las medidas BG y MRH. Las medidas analizadas en este estudio pueden ser utilizadas en el diagnóstico sexual de individuos Brasileños.

Sex prediction by metric and non-metric analysis of the hard palate and the pyriform aperture.

BACKGROUND: Analysis of the bones and bone fragments of the cranium may be a useful tool for sex diagnosis in the identification of human remains which have been exposed to adverse conditions. The object of the present study was to evaluate sex prediction through metric and non-metric analysis of the hard palate (HP) and the pyriform aperture (PA), using macerated skulls of adult individuals. MATERIALS AND METHODS: We analysed 312 dry skulls of adult individuals of both sexes, studying the metric and non-metric characteristics of the HP and PA. The accuracy, sensitivity, specificity and positive and negative predictive values were evaluated. A binary logistic regression and a linear regression were performed. The receiver operating characteristic curve was constructed to analyse the perfor- mance of sex diagnosis. Measurements of the HP and the PA were analysed by ANOVA and Tukey's test. The SPSS v. 20.0 software was used, with a significance threshold of 5%. RESULTS: The shape of the PA presented 61.9% accuracy, 54.4% sensitivity and 65.7% specificity. The shape of the HP presented 51.5% accuracy, 65.6% sen- sitivity and 44.7% specificity. Only the height of the PA functioned as a good predictor of sex. CONCLUSIONS: The height of the PA produced good diagnostic performance (area under curve = 0.764). The height of the PA was the most reliable indicator for sex prediction, and could be used by forensic scientists to identify sex.

Morphometric study of lingual foramina in macerated mandibles to assist in implant placement in the anterior mandibular region.

The object of our study was to contribute to anatomical knowledge of this region with data on the prevalence, number and location of lingual foramina (LF) in dentate and edentate macerated mandibles from Brazilian individuals, differen-tiating them by sex and race. In this way we hope to help dental surgeons with their planning prior to implant placement in the anterior mandibular region. 103 macerated mandibles were analysed. The prevalence, number and location of LF were analysed in the median (MLF) and lateral (LLF) regions and the median (AMLF) and lateral (ALLF) alveolar process regions. Measurements for their location were taken with a digital calliper. 99% of the mandibles presented at least 1 MLF, 82.5% at least 1 LLF, and the frequency of ALLF was 67%. In dentate mandibles, MLF were located in the region superior to the genial spine, and in edentate mandibles in the regions superior and inferior to the genial spine. LLF were located in the middle region in both dentate and edentate mandibles. The height of the symphysis was significantly greater in dentate than in edentate cases. The distance from the alveolar crest (AC) to the MLF was significantly greater in dentate than in edentate mandibles. LF are constant structures, with MLF found more frequently than LLF. Mandibles which present a smaller measured distance from the base of mandible to AC present MFL and LLF closer to AC, implying a greater risk of complication during implant placement. (Folia Morphol 2018; 77, 2: 310-322).

Morphological study of the tuberculum sphenoidalis in macerated skulls of adult individuals.

The tuberculum sphenoidalis (TS) is an anatomical structure of variable form located at the anterior extremity of the infratemporal crest of the greater wing of the sphenoid. The object of this study was to analyse the morphology and frequency of the TS in macerated skulls. We examined 304 macerated skulls belonging to individuals of both sexes, Amerindian and Caucasian. The TS were classified morphologically into spiniform, pyramidal and laminar. TS was present in 96.3% of the skulls; the spiniform type was most frequent (40.3%), followed by pyramidal (37%) and laminar (19%). The most frequent type in females and Amerindian individuals was spiniform; in males and Caucasian individuals, the most frequent types were spiniform and pyramidal. The TS is a frequent anatomical structure on the sphenoid bone. The spiniform and pyramidal types are both very frequent. We suggest that it should be incorporated into international anatomical terminology. The term 'sphenoidal tuberculum' may be the most appropriate.

Evaluación de la posición condilary del espacio articular en atm de individuos chilenos con trastornos temporomandibulares / Assessment of tmj condylar position and joint space in chilean individuals with temporomandibular disorders

La importancia de la relación cóndilo-fosa en la articulación temporomandibular (ATM) aún no es clara, sin embargo algunos autores asocian la posición no céntrica del cóndilo de la mandíbula en la fosa mandibular con trastorno temporomandibular (TTM). Además, otros autores sugieren que la evaluación del espacio articular es una herramienta diagnóstica para la evaluación de las alteraciones de ATM. El objetivo de este estudio fue evaluar la posición condilar y el espacio articular de ATM en individuos chilenos con TTM utilizando tomografía computarizada cone-beam. Fueron seleccionados 19 pacientes de la Unidad de Trastornos Cráneo Cervico Mandibulares-Universidad de Talca, con diagnóstico de TTM según el Research Diagnostic Criteria for Temporomandibular Disorders. Para la evaluación de la posición condilar se utilizó la técnica de Pullinger & Hollender y para la evaluación de los espacios articulares anterior (EAA), superior (EAS) y posterior (EAP) se utilizó la técnica de Ikeda & Kawamura. Un 39,47% de los cóndilos se presentaron en posición posterior, 34,21% en posición central y un 26,31% en posición anterior. Para cóndilos en posición central encontramos: EAA=1,57 mm; EAS=2,20 mm; EAP= 1,54 mm. Para cóndilos en posición posterior encontramos: EAA= 2,18 mm; EAS= 2,02 mm; EAP= 0,98 mm. Para cóndilos en posición anterior encontramos: EAA= 1,00 mm; EAS= 1,89 mm y EAP= 2,07 mm. Concluimos que individuos con diagnóstico de TTM presentan las regiones anatómicas predisponientes a las alteraciones articulares con espacios articulares disminuidos cuando comparados con sujetos asintomáticos. La posición posterior fue la más común en individuos con TTM, sin embargo hubo gran variabilidad en la posición condilar, por ello sugerimos que una posición no centralizada del cóndilo no está necesariamente asociada con la presencia de TTM. Concluimos además que en individuos con TTM los cóndilos ubicados en posición central y posterior presentan EAP disminuido en comparación con individuos sanos.

The importance of the condyle-fossa relationship in the temporomandibular joint (TMJ) is not yet fully clear, however, some authors associate the non-central position of the head of the mandible in the mandibular fossa with temporomandibular disorder (TMD). Furthermore, other authors suggest that assessment of joint space is a diagnostic tool for assessing the TMJ alterations. The aim of this study was to evaluate the TMJ condylar position and joint space in Chilean individuals with TMD using cone-beam computed tomography. We selected 19 patients of "Unidad de Trastornos Cráneo Cervico Mandibulares (UCRACEM) - Universidad de Talca, Chile", who had a diagnosis of TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. The assessment of condylar position was performed using Pullinger & Hollender technique and to evaluate the anterior joint space (AJS), superior joint space (SJS) and posterior joint space (PJS) was used Ikeda & Kawamura technique. Posterior condylar position was found in 39.47% of condyles, central condylar position in 34.21% and anterior condylar position in 26.31%. To condyles in central position we found: AJS = 1.57 mm; SJS = 2.20 mm; PJS = 1.54 mm. To condyles in posterior position we found: AJS = 2.18 mm; SJS = 2.02 mm; PJS = 0.98 mm. To condyles in anterior position we found: AJS = 1.00 mm; SJS = 1.89 mm and PJS = 2.07 mm. We conclude that individuals diagnosed with TMD present anatomical regions predisposing to joint disorders with joint spaces diminished when compared with asymptomatic subjects. Furthermore, the posterior condylar position was the most common in individuals with TMD, however there was great variability in condylar position, therefore we suggest that a non-centralized position of the condyle is not necessarily associated with the presence of TMD. We further conclude that in individuals with TMD the condyles located in central and posterior position present EAP decreased compared with healthy individuals.

Morphological characteristics of the temporomandibular joint articular surfaces in patients with temporomandibular deisorders / Características morfológicas de las superficies articulares de la articulación temporomandibular de pacientes con trastornos temporomandibulares

The knowledge of the anatomical characteristics of the temporomandibular joint (TMJ) articular surfaces is essentital to enable physicians and dentists to recognize the morphological changes that occur in this articulation in patients with temporomandibular disorders (TMD). Several researchers associate the TMD with changes of TMJ articular surfaces. The careful identification of bone changes related to TMJ is critical, since these abnormalities are associated with signs and symptoms of TMD and the knowledge of TMD signs and symptoms is fundamental for correctly diagnosing and for adequate treatment planning. The aim of this study was to evaluate the morphological characteristics of the TMJ articular surfaces in patients with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). In addition, therelationship between increasing age-osteoarthrosis was evaluated. For the sample we selected 19 patients, 17 female and 2 male, referred to the "Unidad de Trastornos Cráneo Cérvico Mandibulares (UCRACEM) - Universidad de Talca, Chile". The imaging assessment was carried out by Cone-Beam Computed Tomography (CBCT). In the imaging analysis of the articular surfaces 11 joints (28.94 percent) showed normal morphology. The bone changes found were: sclerosis, flattening, erosion, osteoarthrosis, osteophytes, subcondral cysts. We found statistically significant difference between increasing age-osteoarthrosis (p=0.00). Considering our results we concluded that bone changes of the TMJ articular surfaces in patients with TMD are very common, with sclerosis as the most frequent finding. It was also possible to conclude that there was a significant association between increasing age-osteoarthrosis.

El conocimiento de las características anatómicas de las superficies articulares de la articulación temporomandibular (ATM) es fundamental para que clínicos y odontólogos reconozcan las alteraciones morfológicas que ocurren en la articulación de pacientes con trastornos temporomandibulares (TTM). Diversos investigadores asocian los TTMs con alteraciones en las superficies articulares de la ATM. La identificación de los cambios óseos relacionados con la ATM es crítica, ya que estos se asocian a signos y síntomas de TTM, y el conocimiento de estos es fundamental para el correcto diagnóstico y adecuada planificación de tratamiento. El objetivo fue analizar las características morfológicas de las superficies articulares de la ATM en pacientes con diagnóstico de TTM, diagnosticado de acuerdo a los Criterios Diagnósticos para Investigación de los Trastornos Temporomandibulares (CDI/TTM), junto con analizar la relación existente entre incremento de edad-osteoartrosis. Fueron seleccionados 19 pacientes, 17 mujeres y 2 hombres, de la Unidad de Trastornos Cráneo Cérvico Mandibulares (UCRACEM) - Universidad de Talca, Chile. La evaluación imagenológica se realizó mediante el examen de Tomografía Computarizada Cone-Beam (TCCB). En el análisis de las superficies articulares, 11 (28,94 por ciento) presentaron morfología normal. Los cambios óseos encontrados fueron: esclerosis, aplanamiento de la cabeza de la mandíbula, erosión, osteoartrosis, osteofitos y quiste subcondral. Hubo relación estadística significativa entre incremento de edad-osteoartrosis (p=0,00). Nuestros hallazgos nos permiten concluir que los cambios óseos en las caras articulares de la ATM en pacientes con TTM son frecuentes, y la esclerosis el hallazgo más común. También se encontró asociación entre incremento de edad y osteoartrosis.

Morphological features of pycnodysostosis with emphasis on clinical and radiographic maxillofacial findings / Características morfológicas de la picnodisostosis con énfasis en hallazgos clínicos y radiológicos maxilofaciales

Pycnodysostosis is a rare genetic syndrome characterized by short stature, obtuse mandibular angle, frontal, parietal and occipital bossing, open fontanels and cranial sutures, midfacial hypoplasia, acro-osteolysis of the distal phalanges, increased bone density, absence or hipopneumatization of the paranasal sinuses and normal laboratory studies. We report the case of a 35-year-old Brazilian man that was referred to a private clinic with history of dysmorphic facies for evaluation. The clinical and radiological features exhibited by the patient led to a diagnosis of pycnodysostosis. We describe the morphological features of pycnodysostosis with emphasis on the clinical and radiographic maxillofacial findings comparing the data obtained from our case with a literature review.

La picnodisostosis es un síndrome genético raro caracterizado por baja estatura, ángulo de la mandíbula obtuso, prominencias frontal, parietal y occipital, suturas craneales y fontanelas abiertas, hipoplasia del tercio medio de la cara, acroosteolisis de las falanges distales, aumento de la densidad ósea, ausencia o hiponeumatización de los senos paranasales y exámenes de laboratorio normales. Se presenta un caso de paciente brasileño, 35 años de edad, sexo masculino, remitido a clínica privada con historia de facies dismórfico para evaluación. Las características clínicas y radiológicas exhibidas por el paciente llevaron al diagnóstico de picnodisostosis. Se describe las características morfológicas de la picnodisostosis con énfasis en los hallazgos clínicos y radiológicos maxilofaciales, comparando los datos obtenidos en nuestro caso con los hallazgos reportados en la literatura revisada.