Does Temporomandibular Joint Magnetic Resonance Imaging Diagnosis Support Clinical Examination Diagnosis Following Diagnostic Criteria for Temporomandibular Disorders?

PURPOSE: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) has been validated as a clinical diagnostic guideline with high-sensitivity and -specificity in identifying TMDs. The purpose of this study was to evaluate the agreement between DC/TMD diagnoses and magnetic resonance imaging (MRI) diagnoses in patients with TMD. METHODS: A prospective cohort study was conducted on patients with TMD. The predictor variable was the clinical diagnosis of TMD based on DC/TMD criteria. The outcome variable was the MRI diagnosis of TMD. The diagnoses used for both the predictor variable and the outcome variable were the same. They were normal, disc displacement with reduction (DDWR), DDWR with intermittent locking, disc displacement without reduction (DDWOR) with limited opening, DDWOR without limited opening, degenerative joint disease, and subluxation. Age and gender of the patients and number of joints evaluated were covariates. Each subject had clinical examination performed by two independent Oral and Maxillofacial Surgeons. All subjects had a bilateral temporomandibular joint (TMJ) MRI performed which was evaluated by a radiologist. The correlation between the clinical and MRI diagnoses was calculated using Cohen's kappa value with a P value of <.05 considered significant. RESULTS: A total of fifty patients (100 TMJs) were enrolled with 38 females and 12 males. The mean ages were 31.92 and 31.75 years, respectively, with a total of 100 TMJs analyzed. Internal derangement was clinically identified in 76% of the joints and with MRI in 69% of joints. The Cohen's kappa value between DC/TMD and MRI diagnoses was found to be κ = 0.720 (P < .01). The respective sensitivity and specificity in determining disc position clinically for DDWR was 1 and 0.96; for DDWR with intermittent locking 0.78 and 0.91; for DDWOR with limited opening 0.9 and 0.98; for DDWOR without limited opening 1 and 0.9; for degenerative joint disease 0.63 and 0.97 and for subluxation 0.28 and 1.00. CONCLUSION: The DC/TMD clinical examination performed well in all types of disc displacement but is less reliable than MRI in detecting the presence of degenerative disc diseases and subluxation.

Evaluation of the effects of arthrocentesis combined with occlusal stabilization splint on disc displacement without reduction-induced acute and closed lock. A prospective cohort study.

OBJECTIVE: Disc displacement without reduction (DDWoR) of the temporomandibular joint is associated with limited mouth opening and arthralgia. In the natural course of the disorder, there is a tendency to progress to degenerative joint diseases. First-line treatment aims to reduce pain and restore joint function. The current study aims to examine the efficacy of an occlusal stabilization splint applied simultaneously with arthrocentesis as first-line treatment in acute and chronic closed-locks. MATERIALS AND METHODS: The present prospective clinical trial included 40 patients who were diagnosed with DDWoR induced chronic (Group 1, n = 23) and acute (Group 2, n = 17) closed-locks. All participants underwent single session arthrocentesis and were applied occlusal stabilization splints. Maximum mouth opening amounts (MMO), Visual analogue scale (VAS), and McGill pain questionnaire (MPQ) scores were evaluated at baseline, on the operation day, and on seven days after the intervention. The obtained data was analyzed with the Wilcoxon signed-rank, Mann-Whitney U, Fisher's exact, Spearman's correlation tests. RESULTS: According to the baseline data, a significant increase was observed in the amount of MMO in postoperative measurements (p = 0.001 and p < 0.001). A statistically significant decrease in MPQ scores was observed in the postoperative period (p < 0.001 and p < 0.001). While a significant difference was observed between the postoperative VAS scores, the scores of Group 2 were lower (p = 0.018). CONCLUSION: Although combined arthrocentesis and occlusal stabilization splint provided significant changes for acute and chronic closed-locks in line with first-line treatment goals, acute closed-lock with arthralgia responded better. CLINICAL TRIAL REGISTRATION NUMBER: NCT05671549.

Role of VEGF I/D variant in suspectibility to odontogenic cyst formation.

Odontogenic cysts, are located in the jawbones, filled with fluid surrounded by epithelial lining and fibrous connective tissue. Vascular endothelial growth factor (VEGF) can induce physiological and pathological angiogenesis and is an endothelial cell-specific mitogen. The aim of the present study was to investigate whether any possible association between the VEGF insertion/deletion (I/D) variant and odontogenic cyst in Turkish population. Clinical information and venous blood samples were collected from 62 odontogenic cyst patients and 98 healthy controls. DNA was isolated from peripheral blood leukocytes. Genotyping of the VEGF I/D variant was done by the polymerase chain reaction (PCR) method. There was a statistically differece in terms of VEGF I/D allele frequencies between patients and controls. VEGF I/D variant I allele frequency was more prevalant in patients compared to controls (p = 0.006411, OR: 2.08, 95%Cl: 1.322-3.272). A statistically significant association was observed when the patients were compared with the controls according to D/D + I/D versus I/I genotype (p = 0.0508, OR: 1.925, 95%Cl: 0.872-4.246). The genotype distribution of VEGF I/D was not statistically different between patients and controls (p > 0.05). For the first time, our results provided evidence supporting the odontogenic cyst formation associated with the I/D variant at the promoter region of the VEGF gene in a group of Turkish population. Although it was seen in our study that the I/D variant in the promoter region of the VEGF gene supports odontogenic cyst formation, large-scale studies are needed to elucidate the effect of this variant on odontogenic cysts.

Evaluation of prevalence of temporomandibular disorders based on DC / TMD Axis I diagnosis in Turkish population and correlation with Axis II.

PURPOSE: The prevalence of DC / TMD diagnosis of individuals with internal derangement of TMJ who want to receive TMD treatment in a tertiary clinic in the Turkish population and comparison of the criteria applied in Axis I and Axis II. METHODS: This study was carried out on 200 individuals older than 18 years of age who have internal disorder of Temporomandibular Joint (TMJ). Diagnostic Criteria for Temporomandibular Disorders (DC / TMD) Axis I and II were applied. RESULTS: The female to male ratio of individuals with internal derangement of TMJ in the Turkish population was 3.5. The Pearson correlation coefficient between the internal derangement of the Right TMJ and the internal derangement of the Left TMJ is 0.804 and has a statistically significant relationship (p <0.05). CONCLUSIONS: For DC / TMD, a more comprehensive study is needed to compare the results found in the Turkish population with other populations.

Evaluation of postoperative changes in the course of mandibular canals impacted by cystic lesions.

BACKGROUND: This study aims to determine the positional alterations in the course of mandibular canal, which were caused by the common cystic lesions in the posterior mandible. Also, the effects of treatment methods on bone formation were evaluated. METHODS: We designed a retrospective cohort study with patients which were treated due to cystic lesions in the maxillofacial region between the years 2012-2018. Forty eight subjects were included and grouped regarding histopathologic diagnoses (radicular dentigerous and odontogenic keratocyst) and treatment methods (enucleation and marsupialization). The mean (range) of patients' age was 31.25 (18-66) years, and there were 32 male and 16 female individuals. The displacement of mandibular canals was verified on preoperative cone-beam computed tomographic images. The measurements of displacement and bone formation were performed on panoramic radiographs. In the statistical analysis of the data, descriptive statistics, parametric independent sample t-test, non-parametric Kruskal Wallis test, and one-way analysis of variance test were utilized. RESULTS: All the evaluated mandibular canals were replaced by a mean(SD) of 5.46(2.59) mm after the lesions eliminated, which was significant in the marsupialization group (p = 0.002). The bone formation was significantly higher in the enucleation group (p = 0.003). The multiple regression analyses revealed that the treatment methods significantly influenced the replacement of mandibular canal (p < 0.001) and the bone formation (p = 0.026). CONCLUSION: In cases where there is an adequate distance between the lesion and the mandibular canal, the enucleation technique was found to be superior in terms of bone formation and the amount of bone height obtained.

A Bibliometric Analysis of International Publication Trends in Total Temporomandibular Joint Replacement Research (1986-2020).

PURPOSE: To conduct a bibliometric analysis that systematically characterizes publications on temporomandibular joint temporomandibular joint replacement from 1986 to 2020. MATERIALS AND METHODS: The articles were retrieved on the same day from the Web of Science Core Collection database of the Web of Science on December 31, 2020 to prevent bias due to daily database updates. Excel 2016, CiteSpace IV, and VOSviewer v1.6.16 were used for analysis. RESULTS: A sum of 610 publications from 1986 to 2020 were analyzed. The highest number of publications were identified and published in the Journal of Oral and Maxillofacial Surgery. The United States had the highest number of publications and the highest H-index. The highest co-citations were from Mercuri. CONCLUSIONS: In this study, developments, the most influential publications, journals, and countries in the field of temporomandibular joint temporomandibular joint replacement were determined based on evidence through bibliometric analysis.

Evaluation of the Efficacy of Auriculotemporal Nerve Block in Temporomandibular Disorders.

AIMS: To investigate the effectiveness of the auriculotemporal nerve block (ATNB) technique in conjunction with noninvasive therapies for the treatment of disc displacement with reduction (DDWR) or without reduction (DDWOR) in addition to arthralgia of the temporomandibular joint (TMJ). METHODS: The data of 22 patients diagnosed with DDWR and DDWOR whose clinical conditions did not improve despite noninvasive treatments were analyzed. ATNB was applied to each patient during the first visit and readministered at 1- and 4-week follow-up visits. Pain intensity values (0 to 10 visual analog scale [VAS] scores) were evaluated pre-ATNB and at the 6-month follow-up visit, and the maximal mouth opening values were measured pre-ATNB and at the 1-week, 4-week, and 6-month follow-up visits. RESULTS: Noninvasive therapies did not make a significant difference in the outcomes between the initial visit and first administration of ATNB (VAS P = .913, MMO P = .151). However, there were significant differences in outcomes between pre-ATNB and the 1-week (MMO P = .000), 4-week (MMO P = .000), and 6-month (VAS P = .027, MMO P = .000) follow-ups. CONCLUSION: ATNB may be considered as a supportive treatment approach in noninvasive TMJ disorder therapies.

A study of chewing muscles: Age-related changes in type I collagen and matrix metalloproteinase-2 expression.

OBJECTIVE: In this study, the aim was to investigate the biochemical, physiological and histological changes that occur in masticatory muscles of the masticatory system with aging. DESIGN: In this study, 14 BALB/c mice were used. Animals were divided into two equal groups of seven. Group I was organized as the group of young animals (n = 7) and Group II as the group of adult animals (n = 7). After routine histological follow-up was performed, the tissues were embedded in paraffin. 4-5 µm thick cross-sections were taken from paraffin-embedded tissues and they were stained with Haemotoxylin and Eosin Type I collagen and Matrix metalloproteinase-2 (MMP-2) immunohistochemically. RESULTS: It was observed that there was a decrease and shrinking in blood vessels due to aging. In young mice, Type I collagen and MMP-2 immunoreactivity in the masseter muscle tissue showed low staining, while Type I collagen and MMP-2 immunoreactivity in the temporal muscle tissue showed moderate staining. Type I collagen and MMP-2 immunoreactivity were significantly higher in the masseter and temporal muscles of elderly mice (p = 0.001). In the H-score evaluation, MMP-2 immune reactivity was significantly lower in young mice than in older mice (p = 0.001). CONCLUSION: It was determined that severe pain complications and functional losses are likely to occur with the increase of degeneration due to aging of masticator muscles.

Does the angulation of the mandibular third molar influence the fragility of the mandibular angle after trauma to the mandibular body? A three-dimensional finite-element study.

The relationship between mandibular third molar (M3) angulation and mandibular angle fragility is not well established. The aim of this study was to evaluate the impact of M3 angulation on the mandibular angle fragility when submitted to a trauma to the mandibular body region. A three-dimensional (3D) mandibular model without M3 (Model 0) was obtained by means of finite-element analysis (FEA). Four models were generated from the initial model, representing distoangular (Model D), horizontal (Model H), mesioangular (Model M) and vertical (Model V) angulations. A blunt trauma with a magnitude of 2000 N was applied perpendicularly to the sagittal plane in the mandibular body. Maximum principal stress (Pmax) (tensile stress) values were calculated in the bone. The lowest Pmax stress values were noted in Model 0. When the M3 was present extra stress fields were found around marginal bone of second molar and M3. Comparative analysis of the models with M3 revealed that the highest level of stress was found in Model V, whereas Model D showed the lowest stress values. The angulation of M3 affects the stress levels in the mandibular angle and has an impact on mandibular fragility. The mandibular angle becomes more fragile in case of vertical impaction when submitted to a trauma to the mandibular body region.

Differential immunohistochemical expression of type I collagen and matrix metalloproteinase 2 among major salivary glands of young and geriatric mice.

OBJECTIVE: This study aimed to demonstrate the immunohistochemical changes associated with MMP-2 and type 1 collagen separately for the first time in the major salivary glands (the parotid, submaxillary, and sublingual glands) that occur with aging in mice. MATERIAL AND METHODS: Fourteen Balb/c white mice (50-80 g) were used in this study. The animals were divided into two equal groups. Group I consisted of young animals (2-month-old) (n=7) and Group II consisted of older animals (18-month-old) (n=7). After routine histological follow-ups, Hematoxylin-eosin (H&E), Masson's Trichrome staining and immunohistochemical staining was performed for type I collagen and MMP-2. RESULTS: We observed that there were age-related decreases in the number of acinar cells, increase in eosinophilic zymogen granules in cells, collagen accumulation in fibrotic areas and dilatation in interlobular ducts. Also, while type I collagen and MMP-2 immunoreactivity were moderate in the salivary glands of the young mice, they were high in the salivary glands of the old mice (p=0.001). In the H-score assessment, MMP-2 immunoreactivity was lower at a significant level in young mice than in old mice (p=0.001). CONCLUSIONS: This study showed that anatomical, physiological and morphological abnormalities occur in all three major salivary glands as a natural consequence of aging.

Macrophage Migration Inhibitory Factor -173GC Variant Might Increase the Risk of Behçet's Disease.

OBJECTIVE: The aim of the present study was to investigate any possible association between the macrophage migration inhibitory factor (MIF) -173GC variant and Behçet's disease (BD) in a group of Turkish patients. SUBJECTS AND METHODS: A total of 111 patients with BD and 100 healthy controls were enrolled in this study. Genomic DNA was extracted from peripheral lymphocytes. The MIF -173GC variant was genotyped using polymerase chain reaction restriction fragment length polymorphism. The allele and genotype frequencies of patients and controls were compared using the χ2 test. RESULTS: A statistically significant difference in the distribution of the genotype was observed between BD patients and healthy controls. The homo-genotype CC was more prevalent in the patient group compared to the control group (p = 0.008, OR: 0.24, 95% Cl: 0.05-0.78). A significant association was observed when the patients were compared with the controls according to GG + GC versus CC ge-notypes (p = 0.003, OR: 1.21, 95% CI: 0.06-0.063). Allele frequencies of the MIF -173GC variant did not show any statistically significant difference between patients and controls. CONCLUSION: In this study, we conclude that the CC ge-notype of the MIF -173GC variant may be a risk factor in the pathogenesis of BD in the Turkish population. However, further studies with larger samples are needed to address the exact role of this variant in BD.

The IL-1Ra gene variable number tandem repeat variant is associated with susceptibility to temporomandibular disorders in Turkish population.

BACKGROUND: Temporomandibular joint disorders (TMD) are a group of disorders involving temporomandibular joint and related structures. Interleukine-1 receptor antagonist (IL-1Ra) is an important anti-inflammatory molecule that competes with other interleukin-1 molecules. This study was designed to investigate the possible association of the IL-1Ra VNTR variant with the risk of TMD in the Turkish population. METHODS: Peripheral blood samples were collected from 100 patients with TMD (23 males, 77 females) and 110 healthy individuals (35 males, 75 females). Genotyping of IL-1Ra 86 bp VNTR variant was evaluated by gel electrophoresis after polymerase chain reaction (PCR). RESULTS: Our results show that there is a statistically significant difference between TMD patients and control group with respect to IL-1Ra genotype distribution and allele frequencies. 1.2, 1.4, and 4.4 genotypes were more common in patients, while 2.2 and 3.3 genotypes were rarer (P<.000). Frequency of alleles 1 and 4 was higher in patient groups (P<.000), whereas alleles 2 and 3 had a lower frequency in patients with TMD (P<.000). CONCLUSIONS: This is the first correlation study that evaluates the association between IL-1Ra gene VNTR variant and TMD. The VNTR variant related to IL-1Ra gene showed a strong pattern of association with TMD that may have a potential impact on disease counseling and management. Larger studies with various ethnicities are needed to establish the impact of IL-1Ra VNTR variant on risk of developing TMD.

Differential immunohistochemical expression of type I collagen and matrix metalloproteinase 2 among major salivary glands of young and geriatric mice

Abstract Objective This study aimed to demonstrate the immunohistochemical changes associated with MMP-2 and type 1 collagen separately for the first time in the major salivary glands (the parotid, submaxillary, and sublingual glands) that occur with aging in mice. Material and Methods Fourteen Balb/c white mice (50-80 g) were used in this study. The animals were divided into two equal groups. Group I consisted of young animals (2-month-old) (n=7) and Group II consisted of older animals (18-month-old) (n=7). After routine histological follow-ups, Hematoxylin-eosin (H&E), Masson's Trichrome staining and immunohistochemical staining was performed for type I collagen and MMP-2. Results We observed that there were age-related decreases in the number of acinar cells, increase in eosinophilic zymogen granules in cells, collagen accumulation in fibrotic areas and dilatation in interlobular ducts. Also, while type I collagen and MMP-2 immunoreactivity were moderate in the salivary glands of the young mice, they were high in the salivary glands of the old mice (p=0.001). In the H-score assessment, MMP-2 immunoreactivity was lower at a significant level in young mice than in old mice (p=0.001). Conclusions This study showed that anatomical, physiological and morphological abnormalities occur in all three major salivary glands as a natural consequence of aging.

Caecum location in laboratory rats and mice: an anatomical and radiological study.

Intraperitoneal (i.p.) injection is the most frequently used method for implementing parenteral therapies in rats and mice. Whether the caecum is located in the right caudal quadrant or left caudal quadrant in the abdominal cavity is not clear. For that reason, we have developed a method for identifying the location of the caecum in rats and mice and thus revealed the most reliable location for i.p. injection in these animals. Two hundred Wistar albino rats and 100 BALB/c mice were used. The location of the caecum was determined by revealing the intra-abdominal organs immediately following euthanasia, photographing the organs, and archiving the images. Both digital photographic images and computed tomographic (CT) sections were analysed in terms of caecum morphology and location. In both rats and mice, the caecum was most commonly located on the animal's left side. It was less frequently located on the right side or in the centre. The caecum was typically comma-shaped, but it was round or S-shaped in some animals. The direction of rotation of the caecum from the basis to the apex was mostly counterclockwise. Additionally, the apex showed a tendency to be evenly centred. This study demonstrated that the caecum was mostly located on the animal's left side; and for that reason, the most suitable location for i.p. injection in these animals was understood to be the right caudal quadrant. Furthermore, when we compared the CT images and autopsy findings, the caecum did not change location in the abdominal cavity postmortem.

Investigation of CD40 gene rs4810485 and rs1883832 mutations in patients with recurrent aphthous stomatitis.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is a common painful disorder affecting oral health, mucosa and overall quality of life. The etiopathogenesis of RAS remains unclear. RAS shows a large genetic diversity among the patients. In present study, we investigated whether CD40 gene rs4810485 and rs1883832 are associated with RAS and its clinical findings in Turkish patients. MATERIALS AND METHODS: Genomic DNA obtained from 387 individuals (160 patients with RAS and 227 healthy controls) were used in the study. CD40 gene rs4810485 and rs1883832 mutations were determined by using polymerase chain reaction with the specific primers. RESULTS: There was no statistically significant difference between the groups with respect to genotype and allele distribution (p>0.05, OR 0.94, 95% CI 0.70-1.28, OR 1.01 95% CI 0.75-1.37, respectively). Additionally, there was no statistically significant difference in the combined genotype analysis of CD40 gene rs4810485 and rs1883832 mutations (p>0.05). CONCLUSIONS: According to our results, we found that CD40 gene mutations are not associated with RAS. We are convinced that CD40 gene mutations do not predispose to develop RAS in Turkish population. To our knowledge, this is the first study regarding CD40 gene rs4810485 and rs1883832 mutations investigated in RAS patients.

Investigation of age-related changes in the expression of aquaporin-1 and aquaporin-5 in the salivary glands of mice.

CONCLUSION: The increased AQP5 expression associated with ageing in glands, which mainly secreted a serous solution, suggests a compensation for the decreased amount of saliva secretion associated with age progression. OBJECTIVE: To investigate the change in aquaporin-1 (AQP1) and aquaporin-5 (AQP5) expression in the salivary glands in young and elder mice. MATERIALS AND METHOD: Twelve female mice from the Balb/C genus (30-50 g) were used. The mice were separated into two groups: Group I had 2-month-old mice and Group II had 18-month-old mice. Salivary glands (glandula parotidea, glandula sublungualis, glandula submaxillaris) were excised and examined immunohistochemically and histopathologically. AQP1 and AQP5 expression of young and elder mice was evaluated using the H-score. A p-value less than 0.05 was considered statistically significant. RESULTS: Upon histopathological examination, the acini of glands were found to be atrophic in elder mice. The number and diameter of intercalated ducts were increased. Indeed, the amount of adipose tissue in the gland was increased. Upon immunohistochemical examination, both AQP1 and AQP5 levels in sublingual glands of elder mice were increased (p < 0.01 and p < 0.001, respectively). However, only AQP5 levels were increased in the parotid gland of elder mice (p < 0.01).

Positive effects of ceftriaxone on pentylenetetrazol-induced convulsion model in rats.

AIMS: Many drugs have been associated with seizures as a side effect. Although they are defined as safe for nervous system. The effect on proconvulsant activity of beta lactam antibiotics have been also reported. We aimed to investigate whether ceftriaxone has an anticonvulsant effect on PTZ-induced seizures in rats. MATERIALS AND METHODS: 36 male Sprague-Dawley rats, 18 of them for EEG recording and 18 of them are for behavioral studies, were randomly divided in two groups: group A for EEG recordings and group B for behavioral assesment. About 70 mg/kg PTZ was used for behavioral studies after Ceftriaxone administiration. About 35 mg/kg PTZ were used for EEG recording after ceftriaxone administiration. The electrodes were implanted on dura over the left frontal cortex and the reference electrode was implanted over the cerebellum for EEG recording. The Racine convulsion scale, first myoclonic jerk onset time, spike percentages, brain MDA and SOD levels were evaluated between the groups. RESULTS: First myoclonic jerk onset time was significantly shorter in saline group than both 200 and 400 mg/kg ceftriaxone groups (p < 0.05). Racine's convulsion scale was significantly lower in 200 and 400 mg/kg ceftriaxone groups than saline group (p < 0.01, p < 0.0001). Both of two ceftriaxone groups have lower spike percentages than the saline group (p < 0.05). Significantly lower MDA levels and higher SOD activity were determined in 200 mg/kg ceftriaxone group compared with the saline group (p < 0.05). CONCLUSION: Our study demonstrated that ceftriaxone has protective effects on PTZ-induced convulsions and on oxidative damage associated with PTZ.