Teriparatide Improves Trabecular Osteoporosis but Simultaneously Promotes Ankylosis of the Spine in the Twy Mouse Model for Diffuse Idiopathic Skeletal Hyperostosis.

Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal disorder in the elderly, which can develop into periosteal hyperostosis and paradoxically into immobilization-associated trabecular osteoporosis. The bone anabolic agent, teriparatide (TPD), seems to be a rational treatment for the immobilization-associated osteoporosis. However, it can lead to development of hyperostosis lesions in DISH patients. Here, we demonstrate TPD effectively treats trabecular osteoporosis while simultaneously promoting ankylosis of the spine in DISH model tiptoe-walking Yoshimura (twy) mice, compared with the ICR mice. Eighteen male twy mice were divided into three groups, and ICR mice were used as a normal control. Subcutaneous injections of TPD or phosphate-buffered saline (PBS) were performed according to three dosing regimens; 40 µg/kg once daily (TPD × 1 group), 40 µg/kg three times daily (TPD × 3 group), and PBS (control; Ctl group). Treatment was commenced at the age of 7 weeks and continued for 5 weeks. Micro-computed tomography (µCT) and histological analysis were performed. Longitudinal µCT study revealed that trabecular bone volume in both the vertebral body and distal femur decreased with time in the Ctl group, but increased dramatically in the TPD × 3 group. The twy mice developed ankylosis of the spine, the progression of which was accelerated with TPD therapy. We also confirmed that TPD therapy promoted ossification of spinal ligaments. Histomorphometrical study revealed that TPD treatment increased bone formation at the vertebrae enthesis region and in the trabecular bone. TPD therapy effectively treats trabecular osteoporosis, but potentially promotes ankylosis of the spine in patients with DISH.

Bisphosphonate therapy and ankylosis of the temporomandibular joint: is there a relationship? A case report.

Bisphosphonates are an effective class of drugs used for various pathologies of bone tissues such as osteoporosis and solid malignant metastatic disease. Although reports on adverse events such as bisphosphonate-induced osteonecrosis of the jaw are common, ankylosis of the temporomandibular joint in an older patient that is possibly associated with bisphosphonate treatment has not, to our knowledge, been previously reported. The patient, a 70-year-old woman with none of the usual causes for ankylosis, presented with bilateral ankylosis to the temporomandibular joints on a background of bisphosphonate treatment. No obvious etiologic factor for the bilateral ankylosis was found; thus, this might represent another complication of bisphosphonate therapy that dentists and physicians need to be aware of. The approach to management of the ankylosis is described.

Retrospective evaluation of facilitated pastern ankylosis using intra-articular ethanol injections: 34 cases (2006-2012).

REASONS FOR PERFORMING STUDY: While surgical arthrodesis is the treatment of choice for osteoarthritis of the proximal interphalangeal joint, some clients are unable to pursue surgery due to costs. A more economical technique was sought using intra-articular ethyl alcohol injections to facilitate ankylosis. OBJECTIVES: To describe the technique and outcome of intra-articular ethyl alcohol injections for facilitated ankylosis of proximal interphalangeal joints with osteoarthritis. METHODS: As a retrospective case series, the medical records (2006-2012) of clinical cases diagnosed with proximal interphalangeal joint osteoarthritis treated with intra-articular ethyl alcohol injections were reviewed. Cases with follow-up of at least 6 months were included. Technique and outcome were determined. Evaluation of outcome was assessed using return to previous performance or intended use and owner satisfaction as the indicators of success. Soundness and level of work are also reported. RESULTS: Thirty-four horses were included in the study. At the time of follow-up, 17 horses (50%) were sound, while 13 horses (38%) were improved but not sound. One horse's lameness was unchanged, and 3 horses were lost to follow-up. The median time until horses became sound or returned to work was 8 months. Six horses had complications, 4 of which were mild and transient. CONCLUSIONS AND POTENTIAL RELEVANCE: The use of intra-articular ethyl alcohol in the proximal interphalangeal joint in horses affected by osteoarthritis appears to be a viable method for facilitated ankylosis if surgical management is not an option.

Severe temporomandibular dysfunction and joint destruction after intra-articular injection of triamcinolone.

BACKGROUND: Steroid injections into joints are frequently used to control symptomatic pain. Risks associated with intra-articular steroid injections are not well documented. METHODS: We report the case of a 29-year-old woman who was referred to a dental surgeon because of a suspected relationship between persisting chronic back pain and an arthrosis of the temporomandibular joint (TMJ). RESULTS: The dental surgeon diagnosed capsulitis of the right TMJ and injected 40 mg triamcinolone into the joint. Within 4 months the patient developed progressive pain and trismus of the right TMJ and the intra-articular injection was repeated. An occlusal splint slightly improved the patients' symptoms but induced crepitus. Magnetic resonance imaging revealed a disk dislocation in the right TMJ and severe necrosis of the condyle. The patient had persisting pain and ankylosis. Surgical restoration of the TMJ revealed a bony apposition in the fossa deformed with the socket of the joint, extensive medial erosion of the condyle and complete destruction of the disk. CONCLUSION: This case report supports earlier observations that intra-articular glucocorticoid injections, if used in a wrong way, may cause severe destruction of a joint.

Ankylosis of the mouse molar after systemic administration of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP).

The proposed homeostasis between fibroblasts in the periodontal ligament and bone cells lining the inner aspect of the alveolar wall is thought to be responsible for maintaining the width of the periodontal ligament space. In the present study, we attempted to interfere with this cellular balance by systemic administration of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP). The maxillary left molars of mice were extracted. They then received a daily subcutaneous injection of HEBP (10 mg P/kg b.w.) for periods of 10, 30 or 50 days. A 2nd group of animals received HEBP without molar extraction. Control groups were injected with Ringer's solution. The animals were sacrificed after the last injection and the mandibles processed for light and electron microscopy. HEBP treatment caused a significant decrease of the width of the periodontal ligament space which was influenced by time. Ankylosis started to occur after 30 days, predominantly in the interradicular areas and was more common around unopposed teeth. At 50 days, signs of resorption were seen along the acellular cementum layer. During HEBP-administration, extensive deposition of newly formed cementum matrix was observed along the cellular cementum but this activity was not seen along the acellular cementum. It is concluded that HEBP interferes with the mechanisms that mediate preservation of the periodontal ligament width.

Repair processes in the periodontium following dentoalveolar ankylosis: the effect of masticatory function.

It has recently been shown that administration of the drug 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) perturbs the homeostasis in the periodontal ligament resulting in an osteoid-mediated ankylosis between the alveolar wall and the root surface. In the present study, the events after discontinuing HEBP administration were investigated and the effect of function on repair of the periodontal ligament was evaluated. In mice, the maxillary left molars were extracted. They then received a daily subcutaneous injection of HEBP (10 mg P/kg b.w.) for a period of 50 days, were killed 24 h, 14, 28, 56 and 112 days after the last injection and their mandibles processed for light microscopy. HEBP administration caused a significant decrease of the width of the periodontal ligament space with localized ankylosis. In the period after discontinuing HEBP treatment, the newly-formed bone did first mineralize and was then partly resorbed resulting in the disappearance of the ankylotic areas. Furthermore, root resorption was seen. Finally, the periodontal ligament regained its normal architecture and width and a new layer of cementum was formed. Functional teeth showed more root resorption than hypofunctional ones and a more rapid repair of the periodontal ligament. It is concluded that in the period after HEBP treatment the periodontal ligament regains its normal width by a repair process including extensive root resorption, that seems to accelerate this process.

Long-term occlusal guidance of a severely intoxicated patient with yusho (PCB poisoning): a case report.

The peculiar dentoorofacial characteristics and 12 years of interdisciplinary management of a patient who was severely intoxicated with the man-made chemical polychlorinated biphenyls (PCBs) are described in this case report. Cephalometric measurements showed that the SNA and SNB angles were reduced but that the developments in height and skeletal maturity were in normal ranges. Gingival hyperpigmentation that was caused by high blood PCB concentration was extremely slow to fade. A cystic mass, diffused trabeculae, and irregular calcification, which were shown on the radiograph and which were caused by high blood levels of PCB, changed gradually. However, the patient had periodontal disease because of horizontal alveolar bone resorption and a deep periodontal pocket, despite good plaque control. After the PCB poisoning the tooth roots were hypoplastic and dilacerated. One root was extracted because of chronic periodontitis. Some teeth were impacted, malposed, or ankylosed.

Calcergy in murine progressive ankylosis.

Murine progressive ankylosis (MPA) is characterized by periarticular ossification and joint ankylosis. We studied calcergy and calciphylaxis in MPA. Calcergy represents a chemical attraction between heavy metal salts and apatite followed by hydroxyapatite deposition around collagen. Mice were injected subcutaneously with FeCl2, PbAcetate, and saline, and sacrificed at intervals between 5 minutes and 14 days. Section of skin and subcutaneous tissues were stained with Von Kossa's stain. No mice developed calcifylaxis. PbAcetate produced calcergy in all mice. MPA mice exhibited calcergy qualitatively and quantitatively the same as normal mice suggesting abnormal calcergy is not responsible for joint ankylosis in MPA.

The influence of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) on dental root resorption in the mouse.

It has been hypothesized that phagocytosis of a layer of mineralized material which is sometimes deposited along the root surface following trauma is an important factor in the initiation of the resorption of teeth. To test this hypothesis, freezing of the mouse incisor periodontium was used as a model where deposition of mineral was prevented by the systemic administration of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP, 10 mg P/kg b.w.) for time periods varying from 2 to 31 days. The animals were killed either 24 hours or 1 month after the last injection and their mandibles were processed for light microscopy. In the HEBP-treated animals, killed 24 hours after the last injection, no mineralized material had been deposited along the root surface, and very little resorption was seen. Large amounts of bone matrix were deposited in the intraperiodontal space (often causing localized ankylosis). In HEBP-treated animals killed 1 month after the last injection, again no layer of mineralized material along the root surface was seen, but now root resorption had become manifest, occupying up to 40% of the cement surface. This occurred irrespective of the duration of HEBP administration. In the saline-treated animals, extensive resorption of the incisor was noted (up to 90% of its surface). It is concluded that the layer of mineralized material deposited after the periodontium is frozen does not play a decisive part in the onset of root resorption. HEBP treatment slows down root resorption but does not prevent it.

N-methyl-N-nitrosourea-induced malformations of the temporomandibular joint in rats.

N-methyl-N-nitrosourea given to pregnant rats intraperitoneally produced hypoplasia of the midface, brachygnathia and a wide variety of hypoplasias of the temporomandibular joint in the offspring. The following deformities were also identified: twinning of the condylar process and ankylosis of the joint.

Tissue reactions to two root canal sealers containing formaldehyde.

Tissue reaction to root fillings using either Endomethasone or N2 was investigated in the premolar teeth of dogs. Periapical inflammation was frequently observed, but of greater significance was the universal evidence of ankylosis and the accompanying resorption of teeth filled with N2. One tooth filled with Endomethasone also exhibited this condition. The results of this study do not support the use of these root canal sealers that contain formaldehyde.

Experimentally induced ankylosis and facial asymmetry in the macaque monkey.

Six Macaca nemestrina were used for induction of ankylosis by different methods. One TMJ capsule was either (a) mechanically damaged, (b) injected with sodium morrhuate, or (c) injected with a strain of Staphylococcus aureus. The other capsule served as a control. Facial asymmetry of varying degrees was evident from dry-skull preparations and histologically. Sodium morrhuate caused the least degree of alteration; mechanical damage, the most. The effects of Staph. aureus injection into the TMJ seemed to depend upon the length of time elapsed since injection. In one animal there was no change at autopsy after two injections several weeks apart, once on each side; in the other, the capsule injected initially showed no change at autopsy, whereas that injected several weeks prior to autopsy was considerably altered. Induction of ankylosis was achieved with varying degrees of success, causing differing degrees of facial asymmetry.

Cervical scoliosis and kidney lesions in sheep following dosage with vitamin D.

A case of cervical deformity of lambs following dosage with vitamin D was investigated. The lesions of a scoliosis are described together with the kidney lesions. It is suggested that doses of vitamin D normally considered to be non-toxic to sheep may prove to be so under certain conditions.

Further reflections on cervical discography.

Ten years ago in THE JOURNAL, I-1 presented evidence that cervical discography was without diagnostic value and was prompting overdiagnosis and serving as an excuse for unnecessary surgical treatment. Evidence has accumulated to uphold this view, and, in my opinion, unless some modification of method and interpretation of the test is forthcoming, it should be abolished.