Development of a measurement system for the mechanical load of functional appliances

Devices called functional appliances are commonly used in orthodontics for treating maxillary protrusion. These devices mechanically force the mandible forward to apply traction force to the mandibular condyle. This promotes cartilaginous growth in the small mandible. However, no studies have clarified how much traction force is applied to the mandibular condyle. Moreover, it remains unknown as to how anatomical characteristics affect this traction force. Therefore, in this study, we developed a device for measuring the amount of force generated while individual patients wore functional appliances, and we investigated the relationship between forces with structures surrounding the mandibular condyle. We compared traction force values with cone-beam computed tomography image data in eight subjects. The functional appliance resulted in a traction force of 339–1477 gf/mm, with a mean value of 196.5 gf/mm for the elastic modulus of the mandible. A comparison with cone-beam computed tomography image data suggested that the mandibular traction force was affected by the mandibular condyle and shape of the articular eminence. This method can contribute to discovering efficient treatment techniques more suited to individual patients.     

Regeneration in transplanted epiphysectomized humeri of rats

Subcutaneous transplantation between 5-day-old littermates of non-inbred rats was used to study the regeneration following partial or total removal of the proximal epiphyseal cartilage of the humerus. More than 200 transplants were followed for periods ranging from 2 to 60 days. No regeneration occurred after a complete epiphysectomy, while a partial regeneration took place in many of the partially epiphysectomized transplants, insofar as the growth plate appeared to be functional for a period of time, but no epiphysis developed. Observations on the early activity of the periosteum and on the fate of the articular cartilage of the transplants were made and compared to findings reported in the literature. The absence of regeneration found in the present study was comparable to that found in earlier studies on the mandibular condyle.     

Mechanical stress promotes matrix synthesis of mandibular condylar cartilage via the RKIP-ERK pathway

Mandibular hypoplasia is a common jaw deformity that affects breathing, occlusal function and facial aesthetics. Stimulating mandibular condylar growing with functional appliances is an ordinary but controversial treatment method in orthodontics. Therefore, it is vital to clarify how functional appliances affect condylar growing. Raf-1 kinase inhibitor protein (RKIP), as an endogenous inhibitory molecule of the ERK signaling, is postulated to involve in stress-induced response to articular cartilage. This study was to reveal the role of RKIP in regulating cartilage matrix synthesis with functional appliance treatment. Here, position rat mandibular forward simulating functional appliance effect to examine the stress-induced modification of mandibular condylar in vivo, meanwhile rat mandibular condylar chondrocytes (Mccs) were subjected to cyclic tensile stress (CTS, 16%, 1 HZ). The results showed that mandibular forward therapy enhanced condylar cartilage growth. The thicknesses of all layers of condylar cartilage were increased significantly. RKIP expression was also increased in the mature cartilage layer. In addition, CTS could enhance extracellular matrix formation and cartilage marker expression (aggrecan and collagen II), which shared a similar expression pattern with RKIP in Mccs. However, CTS induced up-regulation of collagen II and aggrecan was blocked by RKIP knockdown. Nuclear p-ERK, targeting downstream of RKIP, showed a decrease after CTS,which was disappeared in RKIP-knockdown Mccs. Taken together, physiological mechanical stimulation promotes cartilage growth modification by up-regulating RKIP through inhibiting ERK signaling pathway.     

Collagen I and II mRNA distribution in the rat temporomandibular joint region during growth

The distribution of type I and II collagen synthesis in the temporomandibular joint (TMJ) area of 1- to 28-day-old rats was studied after hybridization with probes to pro alpha1(I) and pro alpha1(II) collagen mRNA, and stain intensity through the various cartilaginous zones of the mandibular condyle and other areas of TMJ was assessed. The pro alpha(I) collagen mRNA was detected in the perichondrium/periosteum, in the fibrous and undifferentiated cell layers of the mandibular condyle, in the articular disc, and in all bone structures and muscles. The pro alpha1(II) collagen mRNA was found in the condylar cartilage and the articular fossa. Intensity in the condyle was highest in the chondroblastic layer and decreased towards the lower hypertrophic layer. In the condylar cartilage of the 21- to 28-day-old rats the chondroblastic cell zone was relatively narrow compared with the younger animals, whereas the reverse seems to be the case in the cartilage of the articular fossa. Changes in the pro alpha1(II) collagen mRNA were observed in the osseochondral junction area of the primary spongiosa, in that at the age of 5 days intense staining was found, whereas no staining was observed by 14 days. In the mineralizing zone, however, the majority of osteoblastic cells gave a positive signal with the pro alpha1(I) collagen probe. In conclusion, type II collagen synthesis of the mandibular condyle is restricted to its upper area. This differs from the long bone epiphyseal plate, where this type of collagen is produced virtually throughout the cartilage. Type II collagen synthesis of the fossal cartilage seems to increase as a function of age.     

Localization of CD44 (hyaluronan receptor) and hyaluronan in rat mandibular condyle.

CD44 is a multifunctional adhesion molecule that binds to hyaluronan (HA), type I collagen, and fibronectin. We investigated localization of CD44 and HA in mandibular condylar cartilage compared with the growth plate and the articular cartilage, to clarify the characteristics of chondrocytes. We also performed Western blotting using a lysate of mandibular condyle. In mandibular condyle, CD44-positive cells were seen in the surface region of the fibrous cell layer and in the proliferative cell layer. Western blotting revealed that the molecular weight of CD44 in condyle was 78 to 86 kD. Intense reactivity for HA was detected on the surface of the condyle and the lacunae of the hypertrophic cell layer. Moderate labeling was seen in cartilage matrix of the proliferative and maturative layer. Weak labeling was also seen in the fibrous cell layer. In growth plate and articular cartilage, HA was detected in all cell layers. However, chondrocytes of these cartilages did not exhibit reactivity for CD44. These results suggest that chondrocytes in the mandibular condylar cartilage differ in expression of CD44 from those in tibial growth plate and articular cartilage. Cell-matrix interaction between CD44 and HA may play an important role in the proliferation of chondrocytes in the mandibular condyle.     

Histological, histometrical and fluoride electrode studies of the effects of fluoride on the mandibular condyles in growing newborn rats

The effects of fluoride on the mandibular condyles in growing newborn rats were studied by histological, histometrical and fluoride electrode methods. The layer of cartilage of the mandibular condyle in the animals administered 5, 15, 25 and 35 mg/kg of fluoride for 3 weeks displayed a significant increase in thickness when compared with that of the mandibular condyle in the control animals. The thickening of the cartilage layer was proportioned to the amounts of fluoride administered. The volumetric density of cancellous bone of the condyle in the animals administered 25 and 35 mg/kg of fluoride also increased significantly when compared with that of the condyle in the control animals. The trabeculae of cancellous bone of the condyle in these animals contained large amounts of osteoid. The cancellous bone of the condyle in the animals of the four fluoride groups showed a significantly higher fluoride concentration when compared with that of the condyle in the control animals. The fluoride concentration proportionally increased with the amounts of fluoride administered. The results of the present study indicate that the morphologic changes and the fluoride concentrations in the mandibular condyles of rats receiving fluoride were closely correlated with each other.     

Temporomandibular joint disorder in a patient with multiple sclerosis--review of literature with a clinical report

Temporomandibular disorders are a form of musculoskeletal disorders, which reduce the function of stomatognathic system and they are related to some other diseases causing painful conditions and disorders of oral function. The aim of this paper is to describe a one year follow up clinical case of a female patient with comorbid multiple sclerosis and a relatively rare form of articular disc disorder. Primary clinical diagnostics encompassed manual methods of TMJ examination. Definite diagnosis included radiologic examination. Clinical hyperextensive condyle position was palpated bilaterally and subsequently confirmed by a functional panoramic radiograph of TMJ. The anterior displacement of disc with reduction was diagnosed by magnetic resonance and in the right joint there was a disc displacement upon excursive movement. From relevant literature, the relationship of a number of diseases that can be related to functional disorder of the orofacial system, such as multiple sclerosis, has been described from many aspects. Also, apart from the standard classification of one form of anterior displacement of the disc, made primarily by magnetic resonance, cases of disc displacement upon excursive mandibular movement can rarely be found in literature.     

An in situ hybridization study of the insulin-like growth factor system in developing condylar cartilage of the fetal mouse mandible

The objective of this study was to investigate the involvement of the insulin-like growth factor (IGF) system in the developing mandibular condylar cartilage and temporomandibular joint (TMJ). Fetal mice at embryonic day (E) 13.0-18.5 were used for in situ hybridization studies using [35S]-labeled RNA probes for IGF-I, IGF-II, IGF-I receptor (-IR), and IGF binding proteins (-BPs). At E13.0, IGF-I and IGF-II mRNA were expressed in the mesenchyme around the mandibular bone, but IGF-IR mRNA was not expressed within the bone. At E14.0, IGF-I and IGF-II mRNA were expressed in the outer layer of the condylar anlage, and IGF-IR mRNA was first detected within the condylar anlage, suggesting that the presence of IGF-IR mRNA in an IGF-rich environment triggers the initial formation of the condylar cartilage. IGFBP-4 mRNA was expressed in the anlagen of the articular disc and lower joint cavity from E15.0 to 18.5. When the upper joint cavity was formed at E18.5, IGFBP-4 mRNA expression was reduced in the fibrous mesenchymal tissue facing the upper joint cavity. Enhanced IGFBP-2 mRNA expression was first recognized in the anlagen of both the articular disc and lower joint cavity at E16.0 and continued expression in these tissues as well as in the fibrous mesenchymal tissue facing the upper joint cavity was observed at E18.5. IGFBP-5 mRNA was continuously expressed in the outer layer of the perichondrium/fibrous cell layer in the developing mandibular condyle. These findings suggest that the IGF system is involved in the formation of the condylar cartilage as well as in the TMJ.     

Morphological changes in the internal structure of the articular eminence of the temporal bone during growth from deciduous to early mixed dentition

Previously, bio-mechanical studies on the temporomandibular joint have concentrated mainly on the mandibular condyle while the articular eminence has been largely overlooked. Furthermore, research on the mechanical properties of bone using finite element analysis has focused on the cortical bone in preference to cancellous bone. In this study morphorogical changes in the internal structure of the articular eminence as related to child growth were examined using Micro-CT. Morphometric analysis of samples of cancellous bone representing both deciduous and early mixed dentitions showed an increase in the bone volume fraction and trabecular thickness in the early mixed dentition, and finite element analysis indicated directional transmission of stress as well. These results suggest that the morphology of the trabecular bone was altered to adapt to the functional growth progressed from the deciduous to the early mixed dentition.     

功能矫形前伸青春期大鼠下颌后浅层嚼肌细胞凋亡的研究

目的：研究功能矫形前伸大鼠下颌后浅层嚼肌细胞凋亡的变化规律,探讨功能矫形的肌肉改建机理。方法：选用50只5周龄Sprague-Dawley（SD）雄性大白鼠,随机分为实验组和对照组各25只。实验组大鼠戴自制上颌功能矫治嚣,引导下颌前伸,并打开咬合。利用RT-PCR方法检测两组大鼠浅层嚼肌Bcl-2和Bax基因表达情况,利用TUNEL方法检测浅层嚼肌细胞凋亡情况。结果：①Bcl-2和Bax基因表达随大鼠戴用矫治器时间的延长而升高,至第3周开始下降但仍高于对照组,但Bax的表达高于Bcl-2。Bax/Bcl-2比值随大鼠戴用矫治器时间的延长而升高,至第4周开始下降。②TUNEL实验结果显示浅层嚼肌细胞在戴用矫治器1天后,开始出现凋亡,随着时间延长而增加,至第3周达到顶峰,第4周开始下降。结论：①Bax/Bcl-2比值升高促进浅层嚼肌细胞凋亡。②功能矫形可引起浅层嚼肌细胞凋亡,导致肌肉的结构和功能发生适应性改建。     

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.     

Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint

Objectives: The relationship of bony changes in the condylar surfaces in articular disc displacement without reduction in temporomandibular joint (TMJ) was investigated using diagnostic imaging. The study also evaluated whether the bony changes in the condylar surfaces limit disc and condyle motion, and produce pathological joint sounds. Materials and methods: Thirty‐seven joints in 28 patients diagnosed with degenerative bony changes in the condylar surfaces radiographically and anterior disc displacement without reduction using magnetic resonance imaging (MRI) were studied. The bony changes were assessed by radiographic examination and classified into two types: pathological bone changes (PBCs) including erosion, osteophyte formation and deformity, and adaptive bone changes (ABCs) including flattening and concavity. MRI was performed on the TMJ to examine the configuration and position of the discs. Joint sounds in the TMJ were determined using electrovibratograghy with a joint vibration analysis. Results: The articular disc motion to the condyle in the PBC group was smaller than in the ABC group irrespective of the configuration of the disc, even though there were no significant differences between the two types of bony changes in the disc position during jaw closing. The joint vibration analysis of the TMJ showed that joint sounds with a higher frequency were observed in the PBC group than in the ABC group. High energy levels needed to produce the higher frequencies (over 300 Hz) were observed only in the PBC group.     

Bilan scintigraphique osseux d’une hypercondylie unilatérale

A 10-year-old girl with unilateral condylar hyperplasia was referred to our department for a bone scan. We describe the role of the bone scan in this condition. Unilateral condylar hyperplasia is a rare disease of the mandibular condyle cartilage growth leading to facial deformity. Bone scan demonstrates the active or inactive nature of condylar hyperplasia and orients therapy. A planar bone scan completed by single-photon emission computed tomography (SPECT) combined with CT was performed. Increased uptake of the left mandibular condyle, particularly well demonstrated on SPECT images, was seen. This was confirmed by relative quantification and helped decision making to surgical treatment.     

Ultrastructural changes associated with weaning in the mandibular condyle of the rat

To determine the postnatal structural changes due to increasing articular activity, we have compared the development of the posterior and posterosuperior superficial layers of the rat mandibular condylar cartilage by electron microscopy. In contrast to the uniform development posteriorly, the posterosuperior articular zone showed an extensive remodelling process with collagen breakdown and replacement between the ages of 21 and 28 days, i.e. during weaning. Enlarged spheroid fibroblasts contained numerous micropynocytotic vesicles, collagen debris enclosing vacuoles and a nuclear fibrous lamina enveloping the nucleus; abundant electron-dense amorphous material was present in the matrix as well as covering the surface. An increased number of metabolically active fibroblasts was supplied by the mesenchymal stem cells of the underlying chondrogenic zone. The adaptation process resulted in the replacement of small randomly oriented collagen fibers by large compact bundles running parallel to the glenoid fossa, providing protection to the condyle against excessive wear and tear during incisal biting and grinding. The direct local relationship between (ultra) structure and functional load can be utilized in experimental research on the role of biomechanical forces in mandibular condylar growth and 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 cinefluorographic study of mandibular movement during feeding in the rat (Rattus norvegicus)

The anatomy of the masticatory apparatus, and particularly of the mandibular joints, has led to the view that mandibular movement in the Rodentia is predominantly propalinal, or forwards and backwards in direction. As part of an investigation into the mechanism of function of the mandibular joints in these animals, the feeding behaviour of "August" strain and "Wistar" rats was examined by cinephotography and cinefluorography. The rats were trained to feed on barium sulphate impregnated biscuit and animal cake and to drink radio-opaque liquids. Cinefluorographic recordings of ingestion, mastication, deglutition and of drinking were taken in both the lateral and dorso-ventral projections.
Analysis of the recordings has shown a fundamental separation of ingestive and masticatory activity in the rat, which can be attributed to the morphology of the jaws and particularly to the disparity in the lengths of the mandibular and maxillary diastemas. To bring the incisor teeth into occlusion for ingestion, the mandible is brought forward through the rest position and the condyle into articulation with the anterior part of the fossa. In mastication the condyle is moved backwards to bring the molar teeth into occlusion and the condyle into articulation with the posterior articular facet on the fossa. Once the mandible has been moved into the appropriate position for either ingestion or mastication and deglutition, the movements involved in the separation or chewing of the food are cyclical with combined horizontal and transverse movements as well as the fundamental vertical movement acting to open and close the mouth. The basic movement of ingestion carries the mandibular incisors upwards and forwards across the lingual surfaces of the maxillary incisors, so separating the bite. The grinding stroke of mastication is a horizontal movement carrying the mandibular molars anteriorly across the maxillary.     

Stem-cell-driven regeneration of synovial joints

Mammalian skeletal motion is made possible by synovial joints. Widespread suffering from arthritis and joint injuries has motivated recent effort to regenerate a stem-cell-driven synovial joint condyle implantable in total joint replacement. A single adult stem cell lineage, mesenchymal stem cells, differentiate to form all components of a synovial joint. Whereas localized joint lesions may be repaired by either cell-based or cell-free approaches, regeneration of the entire articular condyle of the synovial joint is unattainable without tissue-forming cells. A series of experiments are presented here to describe our initial attempts to regenerate a synovial joint condyle in the shape and dimensions of a human mandibular condyle, with both cartilaginous and osseous components derived from a single population of rat mesenchymal stem cells. Upcoming challenges are along several intertwining fronts including structural integrity, tissue maturation, mechanical strength and host integration. The synovial joint condyle may turn out to be one of the first 'human body parts' or organs truly regeneratable by stem-cell-derived approaches. Current approaches to regenerate the synovial joint condyle from stem-cell-derived multiple cell lineages may also offer clues for engineering complex organs such as the kidney or liver.     

Ontogeny of relationship of middle ear and temporomandibular (squamomandibular) joint in mammals. II. Morphology and ontogeny in insectivores

The ontogeny of the mandibular joint and the middle ear region was studied in Erinaceus europaeus, Sorex araneus, Talpa europaea and Elephantulus rozeti. During development, a passage connection was found between the mandibular condyle and Meckel's cartilage that is produced by the primordium of the lateral pterygoid muscle. The articular disk is formed apart and it appears later in development.     

Distribution of putative elastic fibers in rabbit temporomandibular joint tissues

This study describes the general distribution of putative elastic fibers in the connective tissues that comprise the articular disk and some of the adnexal tissues of the rabbit temporomandibular joint. Joints were removed en bloc and processed for light-microscopic study. The fibroelastic tissues of the bilaminar zone of the articular disk and the various attachments of the disk to the mandibular condyle contained numerous elastic fibers. Since these morphologic data indicate the presence of many elastic fibers, we suggest that the rabbit temporomandibular joint may serve as a model system to study the functional consequences of selectively altering the quality or quantity of elastic fibers in these tissues.