Adipose tissue-derived extracellular vesicles aggravate temporomandibular joint osteoarthritis associated with obesity.

INTRODUCTION: Temporomandibular joint osteoarthritis (TMJ OA) is a major disease that affects maxillofacial health and is characterised by cartilage degeneration and subchondral bone remodelling. Obesity is associated with the exacerbation of pathological manifestations of TMJ OA. However, the underlying mechanism between adipose tissue and the TMJ axis remains limited. OBJECTIVES: To evaluate the effects of obesity and the adipose tissue on the development of TMJ OA. METHODS: The obesity-related metabolic changes in TMJ OA patients were detected by physical signs and plasma metabolites. The effects of adipose tissue-derived EVs (Ad-EVs) on TMJ OA was investigated through histological and cytological experiments as well as gene editing technology. Alterations of Ad-EVs in obese state were identified by microRNA-seq analysis and the mechanism by which EVs affect TMJ OA was explored in vitro and in vivo. RESULTS: Obesity and the related metabolic changes were important influencing factors for TMJ OA. Ad-EVs from obese mice induced marked chondrocyte apoptosis, cartilage matrix degradation and subchondral bone remodelling, which exacerbated the development of TMJ OA. Depletion of Ad-EVs secretion by knocking out the geranylgeranyl diphosphate synthase (Ggpps) gene in adipose tissue significantly inhibited the obesity-induced aggravation of TMJ OA. MiR-3074-5p played an important role in this process . CONCLUSIONS: Our work unveils an unknown link between obese adipose tissue and TMJ OA. Targeting the Ad-EVs and the miR-3074-5p may represent a promising therapeutic strategy for obesity-related TMJ OA. KEY POINTS: High-fat-diet-induced obesity aggravate the progression of TMJ OA in mice. Obese adipose tissue participates in cartilage damage through the altered miRNA in extracellular vesicles. Inhibition of miR-3074-5p/SMAD4 pathway in chondrocyte alleviated the effect of HFD-EVs on TMJ OA.

Microarray analysis of signalling interactions between inflammation and angiogenesis in subchondral bone in temporomandibular joint osteoarthritis.

Inflammation and angiogenesis, the major pathological changes of osteoarthritis (OA), are closely associated with joint pain; however, pertinent signalling interactions within subchondral bone of osteoarthritic joints and potential contribution to the peripheral origin of OA pain remain to be elucidated. Herein we developed a unilateral anterior crossbite mouse model with osteoarthritic changes in the temporomandibular joint. Microarray-based transcriptome analysis, besides quantitative real-time polymerase chain reaction, was performed to identify differentially expressed genes (DEGs). Overall, 182 DEGs (fold change ≥ 2, P < 0.05) were identified between the control and unilateral anterior crossbite groups: 168 were upregulated and 14 were downregulated. On subjecting significant DEGs to enrichment analyses, inflammation and angiogenesis were identified as the most affected. Inflammation-related DEGs were mainly enriched in T cell activation and differentiation and in the mammalian target of rapamycin/nuclear factor-κB/tumour necrosis factor signalling. Furthermore, angiogenesis-related DEGs were mainly enriched in the Gene Ontology terms angiogenesis regulation and vasculature development and in the KEGG pathways of phosphoinositide 3-kinase-protein kinase B/vascular endothelial growth factor/hypoxia-inducible factor 1 signalling. Protein-protein interaction analysis revealed a close interaction between inflammation- and angiogenesis-related DEGs, suggesting that phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta (Pi3kcd), cathelicidin antimicrobial peptide (Camp), C-X-C motif chemokine receptor 4 (Cxcr4), and MYB proto-oncogene transcription factor (Myb) play a central role in their interaction. To summarize, our findings reveal that in subchondral bone of osteoarthritic joints, signal interaction is interrelated between inflammation and angiogenesis and associated with the peripheral origin of OA pain; moreover, our data highlight potential targets for the inhibition of OA pain.

The crucial role of NR2A mediating the activation of satellite glial cells in the trigeminal ganglion contributes to orofacial inflammatory pain during TMJ inflammation.

Temporomandibular joint inflammatory diseases are a significant subtype of temporomandibular disorders (TMD) characterized by inflammatory pain in the orofacial area. The N-methyl-D-aspartate receptor (NMDAR), specifically the NR2A subtype, was crucial in neuropathic pain. However, the exact role of NR2A in inflammatory pain in the TMJ and the molecular and cellular mechanisms mediating peripheral sensitization in the trigeminal ganglion (TG) remain unclear. This study utilized male and female mice to induce the TMJOA model by injecting Complete Freund's adjuvant (CFA) into the TMJ and achieve conditional knockout (CKO) of NR2A in the TG using Cre/Loxp technology. The Von-Frey filament test results showed that CFA-induced orofacial pain with reduced mechanical withdrawal threshold (MWT), which was not developed in NR2A CKO mice. Additionally, the up-regulation of interleukin (IL)-1ß, IL-6, and nerve growth factor (NGF) in the TG induced by CFA did not occur by NR2A deficiency. In vitro, NMDA activated satellite glial cells (SGCs) with high expression of glial fibrillary acidic protein (GFAP), and both NMDA and LPS led to increased IL-1ß, IL-6, and NGF in SGCs. NR2A deficiency reduced these stimulating effects of NMDA and LPS. The regulation of IL-1ß involved the p38, Protein Kinase A (PKA), and Protein Kinase C (PKC) pathways, while IL-6 signaling relied on PKA and PKC pathways. NGF regulation was primarily through the p38 pathway. This study highlighted NR2A's crucial role in the TG peripheral sensitization during TMJ inflammation by mediating ILs and NGF, suggesting potential targets for orofacial inflammatory pain management.

Type V Collagen Exhibits Distinct Regulatory Activities in TMJ Articular Disc versus Condylar Cartilage During Postnatal Growth and Remodeling.

Understanding matrix molecular activities that regulate the postnatal growth and remodeling of temporomandibular joint (TMJ) condylar cartilage and articular disc will enable the development of effective regenerative strategies targeting TMJ disorder. This study elucidated the distinct roles of type V collagen (collagen V) in regulating these two units. Studying the TMJ of young adult Col5a1+/- mice, we found loss of collagen V resulted in substantial changes in the proliferation, clustering, and density of progenitors in condylar cartilage, but did not have a major impact on disc cells that are more fibroblast-like. Although loss of collagen V led to thickened collagen fibrils with increased heterogeneity in the disc, there were no significant changes in local micromodulus except for a reduction at the posterior end of the inferior side. Following the induction of aberrant occlusal loading by the unilateral anterior crossbite (UAC) procedure, both wild-type (WT) and Col5a1+/- condylar cartilage exhibited salient remodeling, and Col5a1+/- condyle developed more pronounced degeneration and hypertrophy at the posterior end than the WT. In contrast, neither UAC nor collagen V deficiency induced marked changes in the morphology or mechanical properties of the disc. Together, our findings highlight the distinct roles of collagen V in regulating these two units during postnatal growth and remodeling, emphasizing its more crucial role in condylar cartilage due to its impact on the highly mechanosensitive progenitors. Results thus provide the foundation for using collagen V to improve the regeneration of TMJ and the care of patients with TMJ disorder. STATEMENT OF SIGNIFICANCE: Successful regeneration of temporomandibular joint (TMJ) condylar cartilage and articular disc remains a significant challenge due to the limited understanding of matrix molecular activities that regulate the formation and remodeling of these tissues. This study demonstrates that collagen V plays distinct and critical roles in these processes. In condylar cartilage, collagen V is essential for regulating progenitor cell fate and maintaining matrix integrity. In the disc, collagen V also regulates fibril structure and local micromechanics, but has a limited impact on cell phenotype or its remodeling response. Our findings establish collagen V as a key component in maintaining the integrity of these two units, with a more crucial role in condylar cartilage due to its impact on progenitor cell activities.

Biomechanical effects of mandibular deviation on the temporomandibular joint in patients with mandibular prognathism under incisal occlusion.

PURPOSE: The aim of this study was to investigate the biomechanical effects of mandibular deviation on the TMJ in patients with mandibular prognathism before and after orthognathic surgery using three-dimensional finite element analysis. METHODS: Eight patients with mandibular prognathism without deviation, eight patients with mandibular prognathism with deviation and sixteen normal subjects were recruited. Three-dimensional models of the maxillofacial were reconstructed using MIMICS. Nine muscle forces were used to simulate incisal occlusion and contact was used to simulate fossa-disc-condyle interactions. RESULTS: Before surgery, the stress in the TMJ was generally greater in the Pre-MD&MP group than in the Pre-MD group; it was much greater in both groups than in the control group, ranging from about 2 to 12 times as great in the Pre-MD group and from about 5 to 64 times as great in the Pre-MD&MP group. After orthognathic surgeries, the stresses in the Post-MP&MD were significantly reduced by approximately 21.7 % to 93.4 %. And in the Post-MP group, the stresses were reduced by approximately 1.4 % to 51.1 %. CONCLUSION: Mandibular deviation exacerbated the abnormal stress distribution in the TMJ of patients with mandibular prognathism. Orthognathic surgeries could improve the stress distribution in patients with mandibular prognathism (with and without deviation). TMD was closely related to the stress levels of the TMJ.

Systematic review of intervention descriptions in randomised controlled trials with injectable agents for temporomandibular disorder using TIDieR and PEDro scales.

The effectiveness of healthcare depends on clinical trials in which the benefits and harms of interventions are assessed and accurately reported. The aim of this study was to evaluate the quality of the description of randomised controlled trial (RCT) interventions with injectable substances in painful temporomandibular joint disorder after arthrocentesis. RCTs with patients aged ≥ 18 years old, with temporomandibular disorder that analysed the use of intra-articular substances after arthrocentesis, comparisons with arthrocentesis/other injectable techniques, with joint pain and mandibular movement limitation were included. Non-randomised controlled trials, and RCTs in patients with systemic disorders were excluded. The search was performed in the PubMed, Embase, Scopus, Web of Science, Cochrane, and Google Scholar databases. The study description quality was evaluated by Template for intervention Description and Replication (TIDieR). The methodological quality was performed using the Physiotherapy Evidence Database's PEDro scale. The data were submitted to the Spearman correlation test to evaluate the direction and magnitude of the association between the quality of the intervention description and the methodological quality of the RCTs. A total of 9,793 articles were identified, of which 113 were eligible studies and 19 were included. The mean (SD) ratings by TIDieR = 8 (1.07). Absent items in all RCTs that negatively impacted the TIDieR score were: 'Were there adaptations?', 'Were there modifications?' and 'Assessment of adherence'. Other topics were not satisfactorily described: 'Who performed the intervention?' (52.63%), and 'Where it was performed' (36.84%). There was no correlation between TIDieR and PEDro (r=0.009). RCTs with good methodological quality do not contemplate all the TIDieR items and the scale's proper use would contribute to more detailed reports and more faithful reproduction of therapies in clinical research and practice. Complete reports facilitate the understanding of the evidence obtained and serve as a guide in the reproduction of the research in future studies and in clinical application.

Morphologic characteristics of temporomandibular joint on the patients with anterior disc displacement without osteoarthritis: a case-based research.

We investigated the effect of anterior disc displacement without osteoarthritis (ADDwoOA) on the morphology of the temporomandibular joint (TMJ) utilizing three-dimensional (3D) models of 23 asymptomatic individuals and 30 ADDwoOA patients. Statistical analyses between the groups were performed by measuring 10 morphological parameters. ADDwoOA patients showed significantly decreased levels of the sagittal ramus angle (SRA) and joint spaces compared with asymptomatic subjects. Moreover, the patients who had recovered exhibited normal joint spaces levels. Consequently, ADDwoOA caused the condyles to move backward and upward, approaching the articular fossa. Joint spaces can serve as an important observation during the treatment of ADD.

Finite element analysis of stabilization splint pressure distribution in a patient with disc displacement without reduction: A preliminary study.

Purpose: This study was performed to investigate the pattern of condylar pressure distribution in the discs of a patient diagnosed with disc displacement without reduction. Materials and Methods: This research consisted of a pre- and post-test observational clinical study. A patient diagnosed with disc displacement without reduction underwent treatment with an occlusal splint for 3 months. Finite element analysis employed a 3-dimensional model constructed from magnetic resonance images of the patient, taken both before the application of the splint and 3 months after its use. Results: The post-test model demonstrated a decrease in condylar pressure on the disc, with measurements dropping to 72 MPa from the pre-test level of 143 MPa. In the pre-test, the pressure distribution pattern was concentrated on the lateral posterior border, whereas in the post-test, it shifted toward the intermediate zone of the disc. Conclusion: Utilization of a stabilization splint for 3 months resulted in decreased pressure and a marked change in the pressure distribution pattern on the temporomandibular disc.

Delayed Diagnosis of Temporomandibular Joint Dislocation in Severe Stroke Patients.

A 79-year-old woman with a history of left cerebral infarction developed altered consciousness and left hemiplegia. CT of the head revealed a putaminal hemorrhage. She underwent tracheal intubation followed by a tracheostomy for long-term airway management. Despite improved consciousness, the patient continued to experience dysphagia and was fed via a nasal tube. Subsequent axial CT and 3D CT scans revealed an empty glenoid fossa in both temporomandibular joints (TMJs) with the condyles positioned anteriorly, consistent with chronic bilateral anterior TMJ dislocation. After an unsuccessful attempt at manual reduction, closed manual reduction was successfully performed under general anesthesia with muscle relaxants, allowing the patient to resume oral feeding. This case underscores the importance of considering TMJ dislocation in stroke patients with persistent dysphagia. Early diagnosis and timely intervention are crucial for improving patient outcomes in such cases.

Current Trends in Pediatric Orthodontics: A Comprehensive Review.

Pediatric orthodontics is a critical field focusing on the diagnosis, prevention, and treatment of dental and facial irregularities in children. This comprehensive review explores current trends and methodologies in pediatric orthodontics and discusses the multifactorial etiology of malocclusions, including genetic, environmental, and disease-related factors. The importance of proper diagnosis is highlighted, and the extraoral, intraoral, and functional evaluations essential for effective treatment planning are detailed. Various orthodontic conditions such as Class III and Class II malocclusions, abnormal oral habits, arch length discrepancies, anterior and posterior crossbites, open bites, and deep bites are examined in depth. The review also addresses the role of temporomandibular joint disorders (TMDs) and obstructive sleep apnea (OSA) in pediatric patients, emphasizing the need for early and accurate diagnosis to facilitate appropriate intervention. The use of clear aligners in early orthodontic intervention is evaluated given their efficacy and improved patient satisfaction compared to traditional appliances. Additionally, the article discusses the non-advisability of early interception for certain self-correcting malocclusions and the limitations of pediatric orthodontic treatment, including compliance-related issues and the unique anatomical considerations of deciduous dentition. This review aims to provide a detailed understanding of contemporary practices and challenges in pediatric orthodontics, offering insights for clinicians to enhance treatment outcomes and patient care.

Temporomandibular joint space variation and masticatory muscle activation during clenching with full versus partial covering occlusal splints.

OBJECTIVES: Occlusal splints are the main therapeutic choice in the treatment of temporomandibular disorders (TMD). However, their precise working mechanism is unclear. This study aimed to compare the biomechanical effect of three commercially available splint designs (full covering splint, anterior bite splint and posterior bite splint) during biting in a sample of healthy subjects. MATERIALS AND METHODS: Magnetic resonance imaging (MRI) was combined with jaw tracking to measure the minimal intraarticular distance (MID) of 20 human temporomandibular joints (TMJ) whilst simultaneously recording the electromyogram (EMG) of the masticatory muscles. The changes caused by clenching with a bite force of 100 N without splint (baseline) and on each splint were calculated. Repeated measures ANOVA was performed on the means of the MID variations and EMG amplitudes. RESULTS: Clenching on the anterior bite splint resulted in two times less activation of the anterior temporalis muscle than baseline (p = 0.003), full covering (p = 0.011) and posterior bite splint (p = 0.011). MID was reduced by clenching in all conditions, but the reduction was almost three times larger with the anterior bite splint compared to no splint (p = 0.011). The full covering splint and the posterior bite splint did not differ significantly in EMG activation of both masseter and temporalis muscles and MID variation. CONCLUSIONS: This study showed that splint designs have a different impact on the MID and EMG activation while clenching. The anterior bite splint had a greater impact on the reduction of the muscle activation, whereas clenching on the anterior bite splint led to bigger reduction of MID and thus had the greatest influence on alteration in the condylar position. CLINICAL RELEVANCE: The design of the splint can affect MID and muscle activation and is a variable to consider in the treatment of patients with TMD according to their symptoms.

Temporomandibular Joint Disorder and Anterior Scleritis as Initial Presentations of Undiagnosed Rheumatoid Arthritis.

Rheumatoid arthritis is an autoimmune inflammatory process that involves multiple organ systems. While symmetric joint swelling of the extremities are the most widely recognized symptoms, the disease can present in a myriad of different ways, of which scleritis and temporomandibular involvement are less recognized manifestations. While scleritis and temporomandibular disorder (TMD) may at times present in isolation, it is critical to consider their strong association with autoimmune disease as it allows for early diagnosis of inflammatory conditions and allow for the formulation of tailored treatment plans to halt their progression.

Can intra-articular daidzein injection reduce oxidative damage and early osteoarthritis in a rabbit temporomandibular joint model?

BACKGROUND: Oxidative damage and inflammatory cytokines in osteoarthritis (OA) exacerbate the disease course. Daidzein (DZ) has antioxidant and anti-inflammatory effects. This study evaluated the early histopathological effects of intra-articular daidzein injection on experimentally induced osteoarthritis in rabbit TMJs. METHODS: The predictor variable was intra-articular injection of DZ or a saline control. 50 µl of 3 mg/mL MIA solution was injected into the right TMJ of 16 New Zealand rabbits to induce experimental OA. One rabbit was sacrificed after 4 weeks to confirm the formation of the OA model and the OA model was obtained. The remaining 15 rabbits were randomly divided into 2 groups: an experimental group (9 rabbits) and a control group (6 rabbits). On days 1, 7, 14, and 21; 50 µl of saline solution was applied to the right TMJ of the control group and 50 µl daidzein solution (1.8 mg/ml) was applied to the right TMJ to the experimental group. After one week from the date of the last injection, the rabbits were sacrificed, and histopathological and biochemical evaluations were performed. The Shapiro-Wilk test was used to evaluate whether the variables in the study conformed to normal distribution. Mean ± SD (standard deviation) or median (interquartile range (IQR)) was used to show the descriptive statistics of the variables. T-test and Mann Whitney U test were used to compare the control and experimental groups for biochemical changes. The chi-square test was used to show the distribution of histopathological changes variables obtained within the scope of the study based on control and experimental groups. A P-value < 0.05 was considered significant for all evaluations. RESULTS: There were 8 and 6 animate treated with DZ and saline, respectively. There was no statistically significant difference between groups in articular cartilage (p = 0.3), osteochondral junction (p = 0.3), subchondral bone structure (p = 1.0) or chondrocyte appearance (p = 0.4). The experimental group showed significantly lower mean values for Total Oxidant Status (TOS) (p = 0.002) and Oxidative Stress Index (OSI) (p = 0.007). CONCLUSIONS: An intra-articular DZ injection appears to show limited reduction of oxidative damage and early OA in the rabbit TMJ. DZ might represent a promising natural compound with beneficial effects in the management of TMJ-OA.

The Impact of Muscle Energy Techniques on the Temporomandibular Motions Following Extraction Surgery of the Third Molar Tooth: A Randomised Clinical Trial.

BACKGROUND: Trismus and subsequent restricted range of motion in the temporomandibular joint may impede vital activities of daily living. OBJECTIVE: The primary purpose of the current study was to explore the impact of muscle energy techniques on the range of temporomandibular motions in individuals with trismus and restricted range of the temporomandibular motions after third molar extraction surgery. METHODS: Eligible volunteers were randomly assigned to either the intervention or control group. Participants in the intervention group received muscle energy techniques over seven consecutive postoperative days, while those in the control group did not receive any intervention. Both groups adhered to the recommended postoperative healthcare protocol provided by a single dentist. The range of cardinal and linear intra-articular motions of the temporomandibular joint was assessed on the first, second and seventh postoperative days in each group using a vernier calliper and an ultrasound machine, respectively. RESULTS: The range of linear intra-articular motion (p-value < 0.001) and cardinal motion (p-value < 0.032) of the TMJ significantly increased within groups after the first postoperative week. The range of temporomandibular motions, except for the forward displacement of the mandibular condyle (p-value = 0.193), and the range of mandibular retrusion (p-value = 0.339) exhibited a significant difference between groups (p-value < 0.017) after the first postoperative week. CONCLUSION: The current study revealed, for the first time, that muscle energy techniques increase the range of cardinal and linear intra-articular motions in individuals with trismus and restricted range of the temporomandibular motions following third molar extraction surgery. TRIAL REGISTRATION: Clinical Trials: IRCT20211016052783N1.

Custo-Efetividade de Diferentes Tratamentos Minimamente Invasivos Para Disfunção Temporomandibular de Origem Articular sob a Perspectiva do Sistema Público de Saúde Brasileiro.

OBJECTIVE: This study aimed to evaluate the cost-effectiveness (CE) of minimally invasive interventions for pain associated with articular temporomandibular dysfunction from the Brazilian Public Health System (SUS) perspective. METHODS: This is a CE study with a 1-year time horizon. Effectiveness data were extracted from a network meta-analysis, and 2 treatments with moderate levels of evidence certainty were evaluated: arthrocentesis (ARTRO) plus intra-articular corticosteroid (CO) injection and ARTRO plus intra-articular injection of sodium hyaluronate (SH). For CE analysis, the costs of 2 types of SH (low and high molecular weight) and 4 COs (betamethasone [B], dexamethasone acetate [D], methylprednisolone sodium succinate [M], or triamcinolone hexacetonide [T]) were considered. Modeling was conducted using TreeAge Pro Healthcare software, with the construction of a decision tree representing a hypothetical cohort of adults with articular temporomandibular dysfunction. Deterministic and probabilistic sensitivity analyses were performed. In addition, an acceptability curve was developed. RESULTS: The total costs per joint for ARTRO plus low- and high-molecular-weight SH and ARTRO plus COs B, D, M, and T were, respectively, R$583.32, R$763.85, R$164.39, R$133.93, R$138.57, and R$159.86. ARTRO plus dexamethasone acetate was considered cost-effective, with lower cost and higher net monetary benefit than other technologies. In all sensitivity analysis scenarios, it remained cost-effective. It also showed greater acceptability. CONCLUSION: ARTRO plus dexamethasone acetate was considered the cost-effective technology, exhibiting higher net monetary benefit and higher acceptability from the SUS perspective.

Effects of condylar neck inclination and counterclockwise rotation on the stress distribution of the temporomandibular joint.

Three different kinds of condylar inclination were manually modelled anteriorly inclined condylar neck, vertical condylar neck, and posteriorly inclined condylar neck. Three different maxillary impactions were simulated to evaluate the effect of counterclockwise rotation. The von Misses stresses of the disc, compressive stresses of the glenoid fossa, and compressive stresses of the condyle were the highest in the models with posteriorly inclined neck and lowest in the models with vertical condylar neck design. Stresses of the temporomandibular joint increase with the counterclockwise rotation of the maxilla-mandibular complex. The posteriorly inclined neck should be considered a risk factor for condylar resorption with increased counterclockwise rotation.

Two-step cluster analysis based on three-dimensional CT measurements of craniofacial structures in severe craniofacial microsomia.

BACKGROUND: The Pruzansky-Kaban and OMENS classifications do not provide additional details on temporomandibular joint deformities. The aim of this study was to classify and quantitatively define severe forms of craniofacial microsomia based on three-dimensional maxillofacial measurements, focusing on deformities in the zygomatic, temporal, and mandibular bones. METHODS: Maxillofacial computed tomography (CT) scans of children with severe types of craniofacial microsomia (CFM) from 2010 to 2020 were collected. Three-dimensional measurements of zygomatic arch length, height of mandibular ramus, height of maxilla, and occlusal cant were performed. A two-step cluster analysis was conducted based on zygomatic arch continuity, occlusal cant, and the ratio of the affected side to the unaffected side (A/U ratio) for zygomatic arch length, mandibular ramus height, and maxillary height. RESULTS: Fifty patients (32 male, 18 female) were included in the study. They were classified into 2 clusters through cluster analysis. Cluster 1 comprised subjects (44% of patients) with continuous zygomatic arches. Cluster 2 comprised subjects (39% of patients) with discontinuous zygomatic arches. The zygomatic arch A/U ratio in cluster 1 was greater than that in cluster 2, with statistical significance observed. Additionally, the maxilla height A/U ratio in cluster 1 was lower than in cluster 2, also with statistical significance. There was no statistically significant difference observed in the ramus height A/U ratio and occlusal cant between clusters 1 and 2. CONCLUSIONS: Based on craniofacial measurements, severe CFM can be categorized into two types: continuous zygomatic arch and discontinuous zygomatic arch. This cluster analysis complemented the OMENS classification and could assist in the selection and design of prosthetic joints for patients with CFM.

Chondrosarcoma of Temporomandibular Joint: Report of Two Cases.

Chondrosarcoma of the head and neck region is a rare malignant tumor which occurs from 1 to 12% of all of chondrosarcomas. There are only a few case reports of chondrosarcoma in the temporomandibular joint region. This report describes two cases of chondrosarcoma of the temporomandibular joint (TMJ) in a 27-year-old man and a 35-year-old woman. In both cases signs of temporal bone resorption were noticed, and in the first case tumor had intracranial spread. In both cases the tumor was resected in a single block with peritumoral tissues. The aim of this paper is to emphasize the diagnostic and therapeutic difficulty in this pathology.

PAINe - An Artificial Intelligence Based Virtual Assistant to Aid in the Differentiation of Pain of Odontogenic versus Temporomandibular Origin.

INTRODUCTION: Pain associated with temporomandibular dysfunction (TMD) is often confused with odontogenic pain, which is a challenge in endodontic diagnosis. Validated screening questionnaires can aid the identification and differentiation of the source of pain. Therefore, this study aimed to develop a virtual assistant based on artificial intelligence, using natural language processing techniques to automate the initial screening of patients with tooth pain. METHODS: The PAINe chatbot was developed in Python language, using the PyCharm environment and the 'openai' library to integrate the ChatGPT 4 API, and the 'streamlit' library for interface construction. The validated TMD Pain Screener questionnaire and one question about the current pain intensity was integrated into the chatbot to perform the differential diagnosis of TMD in patients with tooth pain. The responses' accuracy was evaluated in 50 random scenarios to compare the chatbot with the validated questionnaire. The Kappa coefficient was calculated to assess the agreement level between the chatbot responses and the validated questionnaire. RESULTS: The chatbot achieved an accuracy rate of 86% and a substantial level of agreement (Kappa = 0.70). Most responses were clear and provided adequate information about the diagnosis. CONCLUSIONS: The implementation of a virtual assistant using natural language processing, based on large language models, for initial differential diagnosis screening of patients with tooth pain, demonstrated substantial agreement between validated questionnaires and the chatbot. This approach emerges as a practical and efficient option for screening these patients.