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PubMed1989

The relationship between condylar guidance and temporomandibular joint clicking.

The association between condylar inclination and temporomandibular joint (TMJ) clicking was tested by measuring the angles of condylar guidance in the sagittal plane during opening and closing movements in 12 subjects with temporomandibular joint clicks and 16 subjects without TMJ clicks. Each subject had tracings made by using a customized functional clutch. All subjects had full dentition and were without symptomatic mandibular dysfunction. Condylar inclinations were measured in parasagittal tracing planes. The travel path of the hinge axis of the condyle's movements was recorded, directly formed, and compared with a four-component axiograph recording that used the axis-orbital plane as a reference for the subjects. The measurements of angles along several distances (millimeters) of condylar guidance from the axis-orbital plane were obtained and evaluated. The measurements were made in the sagittal plane and through opening-closing movements starting from the actual occlusal vertical dimension of each subject. The results do not support the hypothesis that mean angles of the condylar guidance are significantly different in the group with TMJ clicking compared with the group without TMJ clicking.

Adolescent↗
PubMed1999

Arthroscopic findings in osteoarthritic temporomandibular joints.

PURPOSE: This article reports on the results of a study of the arthroscopic findings in the joint surfaces of osteoarthritic temporomandibular joints (TMJs). PATIENTS AND METHODS: Arthroscopy was performed in the upper joint compartment of 40 TMJs in 40 patients. Thirty-one TMJs that were diagnosed with osteoarthritis (OA) constituted the OA group. On the basis of the presence of symptoms related to disc displacement and perforation, OA subgroups were defined. Nine TMJs that were not involved with OA constituted the control group. During the examination, various arthroscopic variables were recorded. Differences between groups and between subgroups were tested statistically. RESULTS: In the OA group, several arthroscopic variables were found significantly more frequently than in the control group. These included retrodiscal tissue redundancy, adhesions, and heightened attachment to the posterior wall of the glenoid fossa; articular disc displacement and limited mobility; and cartilage degeneration in the articular eminence. Moreover, in the OA group, disc displacement was found significantly more frequently in the period after 6 months than during the first 6 months of clinical signs and symptoms. Anterodiscal hypervascularity was found significantly more frequently during the first year than after the first year, as well as more during the first 2 years than after the first 2 years of clinical signs and symptoms, whereas a lowered attachment on the anterior slope of the articular eminence was found significantly more often after 2 years than during the first 2 years of clinical signs and symptoms. CONCLUSIONS: The findings in this study suggest that OA of the TMJ may initially result in synovial tissue hypervascularity, creeping synovitis, and redundancy, and subsequently in adhesion formation and a reduction of the posterior and anterior recess. Because of cartilage fibrillation on the articular eminence, and the subsequently reduced surface smoothness, the articular disc may become displaced. Eventually, disc mobility is limited, and adhesions and a reduced posterior and anterior recess prevail.

Adult↗
PubMed2005

[Temporomandibular joint: MRI diagnostics].

MRI of the temporomandibular joint (TMJ) requires 1.5 T. The radiologist must be familiar with the anatomy and pathology of the TMJ. This review gives a description of MRI protocols for the TMJ, and MRI anatomy and pathology of the TMJ (open and closed mouth) by means of MR images and drawings. Diagnosing of the TMJ related diseases depends on standardized clinical and MR examinations. Therefore close interdisciplinary cooperation between dentist and radiologist is necessary.

Diagnosis, Differential↗
PubMed1995

[The electromyographic activity of the masticatory muscles during temporomandibular joint clicking].

16 patients with painless temporomandibular joint clicking were investigated electromyographically. EMGs were recorded during open-close movement from the superior and inferior heads of the lateral pterygoid muscle, the anterior belly of the digastric muscle and the temporal muscle. TMJ clicking was recorded with a microphone located over the TMJ simultaneously with EMG and incisal movement and velocity. 13 of 16 patients showed various changes in EMG patterns. 3 patients showed no changes in EMG patterns. Evidence that a hyperactive muscle induces TMJ clicking, was not observed. These results indicate that there may be many types of adaptation for TMJ clicking from the viewpoint of the various EMG findings of masticatory muscles. It is suggested that most of the electromyographic changes are not the cause of painless TMJ clicking but their result.

Adolescent↗
PubMed1991

[Autogenous dermal grafts for repair of temporomandibular joint disc perforations].

Perforations of the temporomandibular joints (TMJs) disc were made in the rabbits and repaired with autogenous dermal grafts. The healing process was investigated histologically. Twenty-one rabbits (forty-two TMJs) were divided into 3 experimental groups. Group 1. Six TMJs in which the superior aspects of the discs were exposed by the incision of the articular eminence. Group 2. Fifteen TMJs in which the discs were perforated. Group 3. Twenty-one TMJs in which the dermal grafts were sutured on the disc perforations. The results obtained were as follows: In group 2, all perforations were not repaired, except in one case. In group 3, 14/19 grafted disc perforations were repaired. One week after surgery, young, loose, collagenous tissue from the synovial membrane lined the margins of the perforations. Two weeks after surgery, vascularity from the synovial membrane and young collagen fibers were seen in the area of the repaired perforations. Four weeks after surgery, long and thick collagen fibers bridged the perforations.

Animals↗
PubMed2006

Prediction of volumetric strain in the human temporomandibular joint cartilage during jaw movement.

Human temporomandibular joint loading causes pressurization and flow of interstitial fluid in its cartilaginous structures. This largely determines its load-bearing and maintenance capacity. It was hypothesized that during cyclical jaw movements normal pressure distribution dynamics would enable fluid to reach all necessary cartilage regions. This was tested qualitatively by analysis of local volumetric strain dynamics during jaw open-close movements predicted by a dynamic model of the human masticatory system. Finite-element analysis was performed in separate regions of the articular cartilage layers and articular disc. Heterogeneous patterns of dilatation and compression were predicted. Compression was found to be more dominant during jaw closing than opening. The pressure gradient in the superior layer of the articular disc was more mediolaterally orientated than in its inferior layer. The findings suggest that, where necessary, regionally the cartilage can imbibe fluid to protect the subchondral bone from impact loads effectively. In the disc itself presumably all areas receive regular refreshment of interstitial fluid.

Cartilage, Articular↗
PubMed1999

Automatic recognition of the source of temporomandibular joint sounds.

Sounds evoked in the temporomandibular joint (TMJ) during jaw movements may indicate pathology. They are in dental clinics usually recorded by auscultation and noted in protocols by verbal, subjective descriptions. Time-frequency analysis of electronically recorded TMJ sounds makes possible a more objective and sophisticated analysis. Such sounds were recorded from four subjects and grouped into two sets. One was used for training a classifier, while the other was used for testing its ability to relate a given sound to the subject from which it was recorded. Both scale and time-shift invariant representations, as well as only time-shift invariant representations of the Reduced Interference Distributions of the TMJ sounds were used for pattern recognition. The nearest neighbor, zero-subspace and nearest constrained linear combination classification methods were employed. It was observed that TMJ sound patterns could be very typical for a given person. This indicates that our classification approach can be developed into a useful diagnostic tool by obtaining training sets from patients where a definitive diagnosis of TMJ pathology has been obtained.

Humans↗
PubMed1996

[Meniscal surgical fixation using arthrotomy: impact on the movement of the temporomandibular joint].

The treatment of severe internal derangement of the temporomandibular joint includes, among a number of techniques, the procedure of open surgery to reposition the disc. The American Academy of Orofacial and maxillofacial surgery has established a guidelines to prescribe the best surgical technique as well as criteria to evaluate the post-surgery results. However, little has been done to measure the effects of the procedure on the amplitude of movement of the temporomandibular joint. The aim of this study was to evaluate the kinematics of the TMJ using axiographic registration of the mandibular movements. Twenty-one patients were examined 6 months after surgery. In this group of patients there was a total representation of 35 joints that had received the surgical procedure. The analysis of the results demonstrated the following: - a reduction in the disc condylar range of movement, - an increase of angulation in the tracing of the disccondyle complete translation, - a change in the shape of the condylar paths. The surgical repositionning of the TMJ disc is not a good means to restore the normal range of movement and function of the articulation However, it is a valuable technique when the patient suffers a sever handicap that has not been alleviated by non invasive methods.

Adolescent↗
PubMed1998

Histologic study of synovitis induced by trauma to the rat temporomandibular joint.

OBJECTIVE: The purpose of this study was to establish and histologically examine the time course of synovitis induced by trauma to the rat temporomandibular joint. STUDY DESIGN: Synovitis of the temporomandibular joints of 8-week-old male Wister rats was induced by forced condylar hypermobility, which was administered 10 times successively once a day for 10 days. Pathologic changes were observed microscopically at 2 and 5 days and 2, 4, 6, 8, 10, and 20 weeks after treatment. RESULTS: Histologic findings from the 5th day to the 6th week after treatment were characterized by multiple layers of synovial cells, an increase of dilated vasculature, fibrin deposits, and synovial adhesion. These findings were in good agreement with those reported for the human temporomandibular joint. The pathologic changes decreased with advancing time, and synovitis was not observed at 20 weeks after treatment. CONCLUSION: The present procedure for inducing synovitis of the temporomandibular joint in rats will be useful in understanding the pathogenesis of synovitis in human temporomandibular joints.

Animals↗
PubMed1993

Whiplash and temporomandibular joint dysfunction.

This article examines the relationship between Temporomandibular joint dysfunction and rear-end (whiplash) motor vehicle accidents. The clinical and statistical evidence relating TMJ damage to whiplash is reviewed. The sequence of events regarding the head, neck and jaw movements which occur in these accidents is considered. The jaw movements are discussed in detail. An analysis of the forces resulting from these movements indicates that tensile, compressive and shear forces occur which challenge the integrity of the soft tissues of the Temporomandibular joint. An overview of the mechanisms whereby damage may occur is considered. A more detailed analysis of these mechanisms will be dealt with in further articles, to evaluate the precise magnitude and direction of forces in all phases of the accident.

Accidents, Traffic↗
PubMed1997

Synovial membrane involvement in osteoarthritic temporomandibular joints: a light microscopic study.

OBJECTIVE: To study the light microscopic characteristics of the synovial membrane of osteoarthritic temporomandibular joints to evaluate synovial membrane involvement in the osteoarthritic process. STUDY DESIGN: Synovial membrane biopsies were obtained during unilateral arthroscopy in 40 patients. Thirty-one temporomandibular joints were diagnosed with osteoarthritis. Osteoarthritis subgroups were defined on the basis of the presence of symptoms related to disk displacement and perforation. The control group consisted of nine temporomandibular joints that were not involved by osteoarthritis. During light microscopic examination of the synovial membranes, several light microscopic variables were recorded. Differences between groups and between subgroups were tested with chi 2 or Fisher's exact tests with Mann-Whitney U tests and with Student's t tests. RESULTS: In the osteoarthritis group, the number of synovial intima cell layers was significantly higher, and fibrous intima matrix and fibrous subintima were found significantly more frequently than in the control group. Moreover, in the osteoarthritis group, intima cell hypertrophy in combination with a closely packed cell composition was found significantly more often in the first year of clinical signs and symptoms, whereas intima hyperplasia, fibrous intima matrix, dense surface material, and subintima elastic fibers were found significantly more frequently in the first 2 years of clinical signs and symptoms. CONCLUSIONS: The findings in this study suggest that osteoarthritis of the temporomandibular joint may initially result in synovial intima hyperplasia and cell hypertrophy, and subsequently in deposition of fibrous material in the intima matrix. Eventually, fibrosis of the subintimal tissue may occur in combination with degeneration and subsequent normalization of the synovial intima cell layer. Overall, fibrosis was the most characteristic feature of synovial membranes of osteoarthritic temporomandibular joints. In conclusion, the involvement of the synovial membrane in osteoarthritis of the temporomandibular joint is characterized by an early proliferative phase and a late fibrous phase. It appears that the intense and prolonged fibrous phase may not be a normal appropriate response to an initial insult but rather an aberrant counterproductive response.

Adult↗
PubMed1996

Effects of sustained unilateral molar clenching on the temporomandibular joint space.

OBJECTIVE: To measure the effect of unilateral sustained clenching on the temporomandibular joints, changes in the minimum joint space dimension were assessed. STUDY DESIGN: Ten healthy subjects performed a sustained clench on a bite force transducer in the first molar region for 5 minutes with a constant force of 170 N. Three separate sagittal tomograms were bilaterally obtained with the transducer in place before clenching and during the beginning and at the end of the contraction. Changes were quantified with a computerized image analysis system. RESULTS: The minimum joint space of the contralateral temporomandibular joint was significantly reduced both at the beginning and at the end of the contraction task. Further the minimum joint space was also significantly less at the end than at the beginning of the contraction even though bite force level was identical. The ipsilateral condyle images showed no significant shift in the minimum joint space. CONCLUSIONS: These data suggest that unilateral molar clenching induces a significant reduction of the minimum joint space in the contralateral temporomandibular joint and a sustained condition remarkably increases this change.

Adult↗
PubMed1980

Clinical application of arthroscopy in the temporomandibular joint diseases.

The author presents the methodology and findings of a procedure for arthroscopic examination of the temporomandibular joint cavity by means of a method of puncture of the temporomandibular joint which he developed. The procedure was based on the temporomandibular joint puncture method and involved the tandem insertion of a puncture needle and sheathed needle into the joint cavity and examination of the cavity and cavity wall under perfusion of physiological saline solution. Color photographs of the findings are presented. The advantages by this method are as follows: 1) Direct observation of the cavity, 2) observation of the movement of the joint, 3) biopsy for histopathologic diagnosis, 4) still and cine photography of the findings. Arthroscopy of the temporomandibular joint is at present being applied clinically and is extremely effective in the diagnosis and selection of therapy. It will not doubt play an important role in the diagnosis of the diseases of the temporomandibular joint in the future.

Adolescent↗
PubMed1997

Comparison of different methods of temporomandibular joint disc reconstruction--an animal model.

The optimum method of temporomandibular joint (TMJ) reconstruction has not been defined despite numerous surgical treatments and several well controlled clinical trials. Animal models offer an experimental method allowing direct comparison of standardized surgical techniques. Advanced osteoarthrosis was induced bilaterally in 12 mature merino sheep. Three months alter unilateral surgical reconstruction was performed. Four sheep had discectomy alone, four discectomy with fresh TMJ disc grafts, and four discectomy with fresh auricular grafts. All three surgical methods resulted in some reversal and repair of the osteoarthritic process, with the best result being from the auricular graft, next discectomy alone, next the disc graft, with the untreated osteoarthritic joint showing the most advanced pathosis. This study supports the role of surgical reconstruction in advanced degenerative disease of the temporomandibular joint, in particular, auricular graft reconstruction.

Animals↗
PubMed2004

A longitudinal study of magnetic resonance (MR) evidence of temporomandibular joint (TMJ) fluid in patients with TMJ disorders.

It has been reported that joint effusion, the excessive accumulation of joint fluid in and around the joint, is related to temporomandibular joint (TMJ) disorders such as pain and disk displacement. However, there have been no longitudinal studies of this phenomenon. We performed a longitudinal study on the relationship between joint fluid and various pathological disk conditions. The subjects were 17 patients who visited our facility for orthodontic treatment and were diagnosed using MRI as having internal derangement of one or both TMJs (three males and 14 females; age 12-31 years; mean age 20.5 years). MRI was performed before, during, or after treatment for their disorders. We evaluated the relationship between changes in joint fluid in the joint space and the state of the disk, as well as the presence or absence of pain. Joint fluid was evaluated by classifying the extent of high-signal areas in the upper and lower articular cavities on T2-weighted images. The extent of high-signal areas was classified into five levels. Disk displacement and the extent of displacement were evaluated using proton density-weighted images. Statistical analysis was performed using the chi-square test, and differences in the distribution among the groups were examined. Effusion was noted on the first MRI in nine of the eleven joints (81.8%) in which joint fluid decreased on the second MRI (p<0.01). Displacement remained unchanged or worsened in 18 of the 21 joints (85.7%) that showed joint fluid on the first MRI (p<0.01). Pain was alleviated or absent in all joints in which the fluid decreased. These results suggest that joint fluid may be a factor in the outcome of disk recapture treatment as well as in the evaluation of pain.

Adolescent↗
PubMed1994

Thermographic characterization of internal derangement of the temporomandibular joint.

This study assessed the ability of electronic thermography to identify internal derangement of the temporomandibular joint. The study population consisted of 30 patients with internal derangement verified by temporomandibular joint arthrotomography. Electronic thermography was conducted using an Agema 870 thermographic unit. Thermal assessments included: (1) pattern recognition; (2) pattern symmetry; (3) absolute temperature measurements; (4) delta T measurements; and (5) mean temperature measurements and differences within five designated anatomic zones. Results indicated: (1) low levels of thermal symmetry in patients with internal derangement of the temporomandibular joint, and (2) absolute temperature measurements and mean temperature zone measurements showing large delta T values (0.4 degrees C to 0.8 degrees C). Demonstration of characteristic thermal temporomandibular joint changes suggests that electronic thermography may have potential for assessing internal derangement of the temporomandibular joint. However, more extensive studies are needed before thermographic procedures can be accepted clinically.

Adult↗
PubMed1995

Radiographic signs of temporomandibular joint osteoarthrosis and internal derangement 30 years after nonsurgical treatment.

The aim of this study was to evaluate with radiographs the long-term status of temporomandibular joints that were treated nonsurgically for reducing disk displacement (group 1) or permanent disk displacement (group 2) 30 years ago. Transcranial and transpharyngeal radiographs were made before (T1), 2 to 4 years after (T2), and 30 years after (T3) nonsurgical treatment in 65 former patients with temporomandibular joint osteoarthrosis. To control the results for aging 35 matched subjects (group 3) underwent the same radiographic examination. The number and severity of radiographically visible degenerative changes increased significantly from T1 through T2 to T3 in group 1 and in group 2. The increase in these changes was not simply caused by aging, because in approximately three quarters of the temporomandibular joints in group 3, no radiographically visible degenerative changes were found. At all occasions group 2 showed significantly more severe changes than group 1. At T3 in 64% of the temporomandibular joints in group 1, no or only slight radiographically visible degenerative changes were observed, whereas in 86% of the temporomandibular joints in group 2, moderate to severe changes were observed. A persisting reducing disk displacement in part of the temporomandibular joints in group 1 might explain this significant difference. In 79% of the temporomandibular joints with moderate to severe radiographically visible degenerative changes at T1, no or only slight progression in the extent of these changes was seen between T2 and T3. Apparently a radiographically stable end stage may be reached within a few years after permanent displacement in most cases. It was concluded that in temporomandibular joints with reducing disk displacement, no or only slight radiographically visible degenerative changes develop, even if this condition persists for several decades. On the other hand, in temporomandibular joints with permanent disk displacement, radiographically visible degenerative changes are extensive in the vast majority of cases.

Case-Control Studies↗