中国全新世人群颞下颌关节尺寸的时代变化

本文通过对中国北方地区新石器时代(54例)、青铜铁器时代(189例) 和近代(92例) 成年男性颞下颌关节的多项测量项目的对比、分析, 对中国全新世人群颞下颌关节测量性状的变异问题进行了研究。结果显示近7000年来颞下颌关节的不同部位在全新世不同阶段有不同的变化特点。髁突、冠突在全新世厚度变薄, 髁突的变薄主要在新石器-青铜铁器时代, 冠突的变薄主要在青铜铁器-近代。髁突面积在全新世也在缩小, 在新石器-青铜铁器时代缩小的幅度更大。髁突顶缘弧度的变平、下颌窝的变浅主要发生在新石器-青铜铁器时代。髁突面积/下颌窝面积, 其变化主要发生在青铜铁器时代。这些变化可能与生活环境、食物结构改变、下颌骨与头骨不同的演化速率等有关。     

Twin-block矫治器治疗下颌后缩患者牙颌面硬组织及颞下颌关节变化的临床研究

目的:研究Twin-block矫治器对青少年安氏Ⅱ类错牙合下颌后缩患者牙合面及颞下颌关节的改建能力,从而评估该矫治器的矫治效果。方法:选取20例替牙期及恒牙列早期安氏II类错牙合下颌后缩患者,采用Twin-block矫治器进行治疗,治疗前后均拍摄X线头颅侧位定位片及颞下颌关节核磁共振片,进行牙合面硬组织及髁状突的测量,包括下颌骨长(Co-Gn)、下颌升支长(Co-Go)、下颌体长(Go-Gn)、髁状突宽度、髁状突高度以及关节间隙的测量。结果:与治疗前相比,下颌骨长(Co-Gn)、下颌升支长(Co-Go)、下颌体长(Go-Gn)均显著增加(P0.05),差异均有统计学意义;髁状突高度显著增加(P0.05),髁状突宽度及关节前、上、后间隙无明显变化(P0.05)。结论:Twin-block矫治器对生长发育高峰期患者具有明显的骨矫形作用,髁状突的适应性改建是其主要机制。     

颞颌关节病变的三维显示

颞颌关节是体内唯一左右联动的关节,其主要构成部分是下颌骨的髁状突,它不仅是关节运动的组成部分,也是下颌骨的发育中心,常易遭受很多疾病的罹患,如:肿瘤、外伤、畸形等。由于髁状突处于临近骨结构的包围中,目前所采用的X线平片或体层,因有周围骨结构的重叠,很难清楚显示该部分复杂病变的细节。即使CT的横、冠状面扫描,虽可避免相邻结构的重叠,但对髁状突区各种因素造成的病变,缺乏立体角度显现,     

青铜—铁器时代人类颞下颌关节的形态学研究

本文对采集自河北、山西和内蒙古等地的43例青铜时代和铁器时代颅骨的颞下颌关节进行了形态学研究。上述入骨材料所代表的古代居民,从经济类型上可划分为两大类,分别属于农业民族和游牧民族。研究结果表明,在若干项重要的颞下颌关节形态特征上,青铜-铁器时代居民与现代人差异显著,表明在这些结构上向现代人水平的明显转化可能发生于更晚的历史阶段。从新石器时代到青铜-铁器时代,人类颞下颌关节的若干形态变化与时代发展的同步性并不明显,而主要反映出其与由经济类型所决定的饮食结构之间的密切关系。     

胎儿下颌髁状突发育中软骨细胞凋亡及bcl-2的表达

目的 研究不同胎龄的胎儿下颌髁状突软骨发育中的细胞凋亡及bcl-2蛋白的表达。方法 32例胎儿下颌髁状突软骨按胎龄分为两组：A组（13-22周,17例）;B组（23-33周,15例）,采用原位末端标记法（TUNEL）及免疫组织化学法观察胎儿髁状突软骨发育不同时期细胞凋亡及bcl-2蛋白的表达,并对表达结果作定量分析。结果 两胎龄组中均有TUNEL及bcl-2阳性表达,凋亡细胞A组较B组多,凋亡细胞主要分布于增殖层及成软骨细胞层,肥大层较少;bcl-2阳性细胞主要分布于成软骨细胞层,其次为增殖层,肥大层阳性细胞明显减少,B组bcl-2阳性率高于A组。结论 细胞凋亡参与胎儿下颌髁状突软骨发育,bcl-2与髁状突软骨细胞分化及细胞凋亡有关。     

MMP-1、MMP-3 和MMP-13在慢性睡眠剥夺所致颞下颌关节损伤中的变化

目的：观察MMP-1、MMP-3 和MMP-13 在慢性睡眠剥夺所致颞下颌关节损伤中表达的变化,探讨慢性睡眠剥夺所致颞下颌 关节损伤的可能机制。方法：采用改良多平台(MMPM)建立大鼠慢性睡眠剥夺模型,将90 只成年雄性Wastar 大鼠随机分为小平 台组、网格组和对照组。小平台组和网格组大鼠接受每天18 h的睡眠剥夺和6 h间歇期(10:00-16:00),间歇期大鼠正常笼养。实验 第7、14 和21 d时分别观察动物的行为学观察、检测动物血浆皮质醇(CORT)和促肾上腺皮质激素(ACTH)水平检测,通过免疫印 迹法和实时定量聚合酶链反应(PRC)检测颞下颌关节软骨中MMP-1、MMP-3 和MMP-13 的蛋白和mRNA表达,并通过HE 染色 法观察颞下颌关节结构的变化。结果：与对照组和网格组大鼠相比,小平台组大鼠第14 d和21 d 时髁突软骨中间部位表面纤维 在出现明显的炎症、松解及脱落现象;第21天时的血浆ACTH 和CORT 水平均显著高于网格组和对照组,差异有统计学意义 (P<0.05);第7、14、21 d时关节软骨MMP-1 和MMP-13 蛋白和mRNA 的表达水平均显著上调(P<0.05)。结论：慢性睡眠剥夺所致 的颞下颌关节损伤可能与关节软骨中MMP-1、MMP-3 和MMP-13 的表达上调有关。     

髁突-翼外肌解剖复位与游离复位治疗髁状突骨折的疗效比较

目的:比较髁突-翼外肌解剖复位与游离复位治疗髁状突骨折的疗效,促进髁突形态恢复。方法:收治的80例单侧髁状突骨折患者随机分为两组,每组40例,A组行髁突-翼外肌解剖复位术,B组行髁状突游离复位术,术后3个月、6个月观察髁突形态及下颌骨运动功能变化。结果:A组治愈率为90%,高于B组的70.00%(P0.05);术后3个月A组髁状突吸收、张口受限、开口偏斜、咬合关系紊乱、关节弹响发生率分别为12.50%、15.00%、15.00%、7.50%、12.50%,均低于B组的32.50%、35.00%、37.50%、25.00%、35.00%(P0.05);术后6个月A组张口受限、关节弹响发生率为5.00%、2.50%,均低于B组的20.00%、20.00%(P0.05);两组术后并发症发生率比较差异无统计学意义(P0.05)。结论:髁突-翼外肌解剖复位术保留髁状突骨折患者骨折断端血运,髁突形态及下颌骨运动能力恢复良好,疗效优于髁状突游离复位术。     

慢性睡眠剥夺对颞下颌关节微结构的影响

目的:研究慢性睡眠障碍对大鼠颞下颌关节微结构的影响。方法:采用改良多平台法(MMPM)建立睡眠剥夺模型,将90只Wistar大鼠随机分为3组(n=30),分别为小平台组、网格组和对照组。小平台组和网格组大鼠接受每天18 h的睡眠剥夺和6 h间歇期(10:00—16:00),间歇期大鼠正常笼养。实验第7、14和21天时分别行动物行为学观察、旷场试验和动物血浆检测,并通过HE染色和扫描电镜观察颞下颌关节微结构的变化。结果:与对照组和网格组相比,小平台组大鼠血清促肾上腺激素(ACTH)和皮质醇(CORT)水平均增高(P<0.05),髁突软骨HE染色显示软骨细胞层次及厚度改变;扫描电镜结果显示关节盘表面纤维排列松散。结论:慢性睡眠障碍可能导致颞下颌关节微结构发生病理性改变。     

非诱导脂肪干细胞膜片复合PRF修复兔髁状突软骨缺损

目的:探索非诱导ADSCs膜片/PRF复合植入物修复兔子下颌骨髁状突软骨缺损的可行性及效果。方法:选取36只3月龄新西兰雄性大白兔,随机分为3个组即ADSCs膜片/PRF组、PRF组、空白对照组,在3%戊巴比妥钠麻醉下解剖暴露出髁状突关节面并用裂钻分别在双侧髁状突软骨面上制备一3 mm直径、3 mm深的髁突表面软骨缺损区,按实验设计每个分组分别填入相应的植入物。分别在术后4周、8周、12周处死相应时间点的动物采集髁突标本,标本进行大体及组织学检查比较。结果:术后12周时空白对照组的下颌髁状突软骨缺损未能修复,PRF组有少量不规则、不连续的软骨形成,ADSCs膜片/PRF组的修复效果较好,表面软骨接近正常纤维软骨,与周围软骨连续性较好。组织学染色也显示ADSCs膜片/PRF组优于PRF组和空白对照组。结论:证明了ADSCs膜片/PRF复合物修复髁状突软骨缺损的可行性。     

雌激素及其受体与颞下颌关节疾病的研究进展

颞下颌关节紊乱病的患病率存在性别与年龄上的差异,这引起学者们对雌激素及其受体与颞下颌关节组织变化关系的广泛注意.雌激素通过其受体介导而发挥其生物学效应,调节颞下颌关节组织多种代谢活动,从而可能在颞下颌关节紊乱病的病理生理过程中起作用.     

Osteophyte formation and matrix mineralization in a TMJ osteoarthritis mouse model are associated with ectopic hedgehog signaling

The temporomandibular joint (TMJ) is a diarthrodial joint that relies on lubricants for frictionless movement and long-term function. It remains unclear what temporal and causal relationships may exist between compromised lubrication and onset and progression of TMJ disease. Here we report that Proteoglycan 4 (Prg4)-null TMJs exhibit irreversible osteoarthritis-like changes over time and are linked to formation of ectopic mineralized tissues and osteophytes in articular disc, mandibular condyle and glenoid fossa. In the presumptive layer of mutant glenoid fossa's articulating surface, numerous chondrogenic cells and/or chondrocytes emerged ectopically within the type I collagen-expressing cell population, underwent endochondral bone formation accompanied by enhanced Ihh expression, became entrapped into temporal bone mineralized matrix, and thereby elicited excessive chondroid bone formation. As the osteophytes grew, the roof of the glenoid fossa/eminence became significantly thicker and flatter, resulting in loss of its characteristic concave shape for accommodation of condyle and disc. Concurrently, the condyles became flatter and larger and exhibited ectopic bone along their neck, likely supporting the enlarged condylar heads. Articular discs lost their concave configuration, and ectopic cartilage developed and articulated with osteophytes. In glenoid fossa cells in culture, hedgehog signaling stimulated chondrocyte maturation and mineralization including alkaline phosphatase, while treatment with hedgehog inhibitor HhAntag prevented such maturation process. In sum, our data indicate that Prg4 is needed for TMJ integrity and long-term postnatal function. In its absence, progenitor cells near presumptive articular layer and disc undergo ectopic chondrogenesis and generate ectopic cartilage, possibly driven by aberrant activation of Hh signaling. The data suggest also that the Prg4-null mice represent a useful model to study TMJ osteoarthritis-like degeneration and clarify its pathogenesis.     

Temporomandibular joint osteoarthritis in a British skeletal population

The potential role of dental function in TMJ osteoarthritis is examined in an ancient British population. Human skeletal remains from five archaeological sites in England (n = 369) were studied to assess the associations between the presence of osteoarthritis and dental function variables, in particular antemortem tooth loss and dental attrition. Individuals aged over 17 years with at least a portion of either the left or right TMJ were included in the study. Each individual was scored for the occurrence of arthritic lesions on the mandibular condyle and glenoid fossa, the level of dental attrition, and antemortem tooth loss. A loglinear analysis was performed with osteoarthritis as the dependent variable and tooth loss, attrition, sex, and age as the independent variables. Tooth loss and sex are not significantly associated with TMJ osteoarthritis when attrition and age are included in the analysis. Attrition is significantly associated with osteoarthritis even when the analysis corrects for age. The significant association of attrition with osteoarthritis suggests that dental functions may have an influence, separate from ageing, on the development of TMJ osteoarthritis.     

TMJ osteoarthritis: a new approach to diagnosis

Disorders of the temporomandibular joint (TMJ), including TMJ osteoarthritis (TMJ OA), are the topic of intensive clinical research; however, this is not the case in the archaeological literature, with the majority of work on the subject ceasing with the early 1990s. The methods employed in the diagnosis of TMJ OA within the archaeological work appear nonrepresentative of the disease and may have led to erroneous assumptions about the pattern and prevalence of OA. This current work presents a new method for evaluating OA specifically for the TMJ, considering both the biomechanics of the joint and the mechanisms of the disease. Totally, 496 specimens (including a group of modern documented specimens) were analyzed for the presence of TMJ OA using the following criteria: eburnation, osteophytes (marginal and new bone on joint surface), porosity, and alteration to joint contour. The results suggest that eburnation occurs rarely in the TMJ, so should not be used as an exclusive criterion. Rather a combination of at least two of the other criteria should be used, with osteophytes and porosity occurring the most frequently on both the mandibular condyle and articular eminence. Additionally, the prevalence of TMJ OA in the modern assemblage was similar to that observed in current clinical research, suggesting that the method employed here was able to produce a reasonable approximation of what is found in contemporary living populations.     

BMPRIA Mediated Signaling Is Essential for Temporomandibular Joint Development in Mice

The central importance of BMP signaling in the development and homeostasis of synovial joint of appendicular skeleton has been well documented, but its role in the development of temporomandibular joint (TMJ), also classified as a synovial joint, remains completely unknown. In this study, we investigated the function of BMPRIA mediated signaling in TMJ development in mice by transgenic loss-of- and gain-of-function approaches. We found that BMPRIA is expressed in the cranial neural crest (CNC)-derived developing condyle and glenoid fossa, major components of TMJ, as well as the interzone mesenchymal cells. Wnt1-Cre mediated tissue specific inactivation of BmprIa in CNC lineage led to defective TMJ development, including failure of articular disc separation from a hypoplastic condyle, persistence of interzone cells, and failed formation of a functional fibrocartilage layer on the articular surface of the glenoid fossa and condyle, which could be at least partially attributed to the down-regulation of Ihh in the developing condyle and inhibition of apoptosis in the interzone. On the other hand, augmented BMPRIA signaling by Wnt1-Cre driven expression of a constitutively active form of BmprIa (caBmprIa) inhibited osteogenesis of the glenoid fossa and converted the condylar primordium from secondary cartilage to primary cartilage associated with ectopic activation of Smad-dependent pathway but inhibition of JNK pathway, leading to TMJ agenesis. Our results present unambiguous evidence for an essential role of finely tuned BMPRIA mediated signaling in TMJ development.     

Relationships between geometry and kinematic characteristics in the temporomandibular joint

Motions of the temporomandibular joint (TMJ) involve both translation and rotation; however, there may be substantial variations from one human to another, and these variations present significant difficulties when designing TMJ prostheses. The disc–condyle glides along the temporal bone and the condyle centre describe a curve that depends on the individual morphology.

This study analyses disc–condyle rotatory and translatory displacements moving all along the temporal bone facets which are mainly composed of two areas: the articular tubercle slope (ATS) and the preglenoid plane separated by the articular tubercle crest. Displacements were quantified using 3D video analysis, and this technique was computer-assisted.

From a population of 32 volunteers, we were able to establish a correlation between the kinematic characteristics of the joint and the disc–condyle trajectories. This study quantifies the geometrical characteristics of the ATS and their inter-individual variations, which are useful in TMJ prosthesis design.     

A model of temporomandibular joint function in anthropoid primates based on condylar movements during mastication

The hypothesis that the shape of the bony temporomandibular joint (TMJ) is functionally related to sagittal sliding of the condyle during mastication is tested, and a model of the relation of sagittal sliding to mandibular size, TMJ shape, and diet is developed. Sagittal sliding is defined as fore-aft motion of the condyle during mandibular translation and/or angular rotation. Ascending ramus height is used as a structural correlate of the distance between the condyle and the mandibular axis of rotation (CR). Cineradiographic data on sagittal sliding and gape during mastication in Ateles spp., Macaca fascicularis, Papio anubis, and Pan troglodytes in conjunction with comparative data on mandibular size and TMJ shape are used to evaluate the hypothesis. The results show that 1) linear and angular gape are highly positively correlated with sagittal sliding, 2) pure mandibular translation is rare during mastication, 3) the CR is rarely if ever located at the condyle during mastication, 4) angular gape should be standardized in interindividual comparisons of sagittal sliding, and 5) the height of the ascending ramus (and by inference the CR-to-condyle distance) is highly positively correlated with absolute sagittal sliding. Sagittal sliding relative to the length of the articular eminence was the variable used to explore the relation between TMJ shape and sliding. This variable standardized absolute sagittal sliding relative to joint size. The relative depth and orientation of the articular eminence were not correlated with relative sagittal sliding. The anteroposterior curvature of the condyle was highly negatively correlated with relative sagittal sliding. Flat condyles are associated with large amounts of relative sagittal sliding. A flat condyle increases joint contact area, which reduces joint stress. A flat condyle also increases joint congruence, and this may facilitate the combined sliding and rolling motion of the condyle when the sliding motion is relatively large. The shape of the entoglenoid process was also positively correlated with relative sagittal sliding. A relatively large entoglenoid process may help to guide sagittal sliding and prevent excessive mediolateral sliding of the condyle. The functional model makes a number of predictions about the correlations between food consistency and food object size, mandibular size, TMJ shape, and sagittal sliding of the condyle during mastication and incision. Am J Phys Anthropol 109:67–88, 1999. © 1999 Wiley-Liss, Inc.     

Development of the temporomandibular joint in miniature pig embryos

The temporomandibular joint (TMJ) is a synovial joint involved in sliding and hinge movements of lower jaw in mammals. Studies on TMJ development in embryos have been mainly performed using rodents. However, the TMJ structure in rodents differs in several aspects from that in humans. There are few studies on the embryonic development of TMJ in large mammals. In the present study, we investigated the embryonic developmental characteristics of the TMJ in pigs histologically. Embryonic day 35 (E35), E45, E55, E75, E90, and postnatal day 1(P1) embryos/fetuses from the pigs were used for the study. The results showed condensation of mesenchymal cells on E35. The inferior articular cavity was formed on E45, together with a narrow crack in the superior articular cavity region. The superior and inferior articular cavities and articular disc of the TMJ were completely formed on E55. On E75, the condyle showed an obvious conical shape and the superior and inferior joint cavities were enlarged. Furthermore, the mandibular ramus and mandibular body under the neck of the condyle were ossified from E75 to P1 day. The chondrocyte layer of the condyle was significantly thinner from E75 to P1. It is speculated that the spatiotemporal development of the TMJ in miniature pig embryos is similar to that in humans. Embryonic development of the pig TMJ is an important bridge for translating the results of rodent research to medical applications.     

Changes in articular eminence morphology with dental function

Measurements of mandibular fossa depth and slope of the articular eminence were obtained for human skeletal samples chosen to represent a wide spectrum of subsistence strategies and oral function: hunter-gatherers (Eskimos, Australians), American Indians dependent to a variable extent on maize agriculture, and early twentieth century American whites and blacks. In the Eskimo and Australian samples, a generalized and steady increase in fossa depth and slope was observed with increasing functional age (tooth wear) through wear level 5 (of 8), followed by a levelling off or slight decrease in fossa depth in later wear levels on the anterior teeth and a sharp decrease in fossa depth in later wear levels on the molars. Although much less consistent due in part to extensive and early molar loss, patterns of variation in the remaining samples were characterized overall by a decrease in fossa depth and slope with increasing wear, especially on the molars. Further, in those samples with high incidences of posterior tooth loss, fossa depth was routinely less and the eminence more gently sloped in subsamples having experienced molar loss than in subsamples retaining all their molars. These data provide evidence that the temporomandibular joint (TMJ) undergoes continuous morphological alteration throughout adult life, and that these alterations are probably mediated by dental function. Moreover, they suggest that differences in patterning of such alterations may exist among human groups with contrasting patterns of tooth use.     

Lubricin Protects the Temporomandibular Joint Surfaces from Degeneration

The temporomandibular joint (TMJ) is a specialized synovial joint essential for the mobility and function of the mammalian jaw. The TMJ is composed of the mandibular condyle, the glenoid fossa of the temporal bone, and a fibrocartilagenous disc interposed between these bones. A fibrous capsule, lined on the luminal surface by the synovial membrane, links these bones and retains synovial fluid within the cavity. The major component of synovial fluid is lubricin, a glycoprotein encoded by the gene proteoglycan 4 (Prg4), which is synthesized by chondrocytes at the surface of the articular cartilage and by synovial lining cells. We previously showed that in the knee joint, Prg4 is crucial for maintenance of cartilage surfaces and for regulating proliferation of the intimal cells in the synovium. Consequently, the objective of this study was to determine the role of lubricin in the maintenance of the TMJ. We found that mice lacking lubricin have a normal TMJ at birth, but develop degeneration resembling TMJ osteoarthritis by 2 months, increasing in severity over time. Disease progression in Prg4 ^−/− mice results in synovial hyperplasia, deterioration of cartilage in the condyle, disc and fossa with an increase in chondrocyte number and their redistribution in clusters with loss of superficial zone chondrocytes. All articular surfaces of the joint had a prominent layer of protein deposition. Compared to the knee joint, the osteoarthritis-like phenotype was more severe and manifested earlier in the TMJ. Taken together, the lack of lubricin in the TMJ causes osteoarthritis-like degeneration that affects the articular cartilage as well as the integrity of multiple joint tissues. Our results provide the first molecular evidence of the role of lubricin in the TMJ and suggest that Prg4 ^−/− mice might provide a valuable new animal model for the study of the early events of TMJ osteoarthritis.     

Relationships between geometry and kinematic characteristics in the temporomandibular joint

Motions of the temporomandibular joint (TMJ) involve both translation and rotation; however, there may be substantial variations from one human to another, and these variations present significant difficulties when designing TMJ prostheses. The disc-condyle glides along the temporal bone and the condyle centre describe a curve that depends on the individual morphology. This study analyses disc-condyle rotatory and translatory displacements moving all along the temporal bone facets which are mainly composed of two areas: the articular tubercle slope (ATS) and the preglenoid plane separated by the articular tubercle crest. Displacements were quantified using 3D video analysis, and this technique was computer-assisted. From a population of 32 volunteers, we were able to establish a correlation between the kinematic characteristics of the joint and the disc-condyle trajectories. This study quantifies the geometrical characteristics of the ATS and their inter-individual variations, which are useful in TMJ prosthesis design.