Tatsunori Iwabe

Influence of Friction at Articular Surfaces of the Temporomandibular Joint on Stresses in the Articular Disk: A Theoretical Approach with the Finite Element Method

The present study was designed to assess stress and displacement of the temporomandibular joint (TMJ) disk during jaw opening with different frictional coefficients (micro) from 0.0001 to 0.5 at the TMJ disk and bony component interfaces using three-dimensional finite element (FE) models of individual TMJs based on magnetic resonance (MR) images. An asymptomatic female volunteer and a female patient with anterior disk displacement without reduction were selected, and serial sagittal and frontal slices of their MR images were used for the TMJ reconstruction procedure. The condylar movement was recorded during jaw opening by a Gnatho-hexagraph and used as the loading condition for the subsequent stress analysis of the model. In the asymptomatic subject, relatively high von Mises stresses were observed in the anterior and lateral regions of the disk during jaw opening, and the superior boundary, contacting with the glenoid fossa, exhibited lower stresses than those on the inferior boundary facing the condyle. In the symptomatic subject, although the stress value in the disk was relatively low, the posterior connective tissue exhibited high stress throughout jaw opening. Additional increments in stress values and disk displacement were observed as the coefficient of friction increased, especially in the asymptomatic subject. It is concluded that an augmentation in the friction between the disk, glenoid fossa, and condyle produces an increment in stress and displacement of the disk.

Administration of MK-801 decreases c-Fos expression in the trigeminal sensory nuclear complex but increases it in the midbrain during experimental movement of rat molars.

Various studies reported c-Fos expression in the neurons in the trigeminal sensory nuclear complex (TSNC) following experimental tooth movement, which implies pain transmission to the central nervous system. Meanwhile, MK-801, a noncompetitive antagonist of N-methyl-D-aspartate (NMDA) receptors, was shown to markedly reduce the expression of c-Fos in the trigeminal subnucleus caudalis (Vc) following noxious stimulation but to enhance c-Fos expression markedly in other brain regions, i.e., the neocortex, dorsal raphe and thalamic nuclei. In the present study, we examined the nature of c-Fos expression in the brainstem including the TSNC and midbrain following administration of MK-801 and/or experimental movement of the rat molars. Twelve hours after the beginning of experimental tooth movement, c-Fos was expressed bilaterally in the superficial laminae of Vc (Vc I/II), dorsomedial areas of the trigeminal subnucleus oralis (Vodm) and rostro-dorsomedial areas of the trigeminal subnucleus oralis (Vor) with the ipsilaterally dominant distribution, but hardly in the periaqueductal gray (PAG), dorsal raphe nucleus (DR) and Edinger-Westphal nucleus (EW). Intraperitoneal administration of MK-801 (0.03, 0.3 and 3.0 mg/kg) prior to the onset of experimental tooth movement reduced c-Fos in the TSNC (Vc I/II, Vodm and Vor) but increased it in the nucleus raphe magnus (NRM), ventrolateral PAG (vl PAG), DR and EW. These results highly emphasize that during experimental tooth movement, a blockade of NMDA receptors induces neuronal suppression in the TSNC but increases neuronal activity in the descending antinociceptive system including the NRM, vl PAG, DR and EW.

Viscoelastic properties and residual strain in a tensile creep test on bovine temporomandibular articular discs

This study was designed to evaluate the creep characteristics and residual strain of bovine temporomandibular joint (TMJ) discs in tension. Twenty discs were divided into three specimens each: central, lateral and medial regions. Tension of 1.0 MPa was applied and sustained for 20 min to the specimens from 10 right-side discs, and tension of 1.5 MPa to specimens from 10 left-side discs. After the period of tension for creep, the specimens were removed from the tension devices and restoration observed for 20 min. Time-dependent creep curves showed a marked change in strain during the initial 5s. The essential time delay in strain ceased after 2 min, and strain reached an almost steady level after 3 min. At a tensile stress of 1.5 MPa, a strain of 14.5% on average was produced after 20 min creep in the central specimens; peripheral specimens showed strains of 12.4% on average. There were significant differences in strain between the central and peripheral specimens. The residual strain after 20 min restoration was 0.93% on average and there were no significant regional differences. This creep feature could be well represented by a generalized linear viscoelastic model. It was concluded that the regional differences in viscoelasticity might be caused by the complicated articulating functions of the TMJ, and that the residual strain caused by sustained stress could be an important factor in disc deformation.

An Adult Case of Skeletal Open Bite with a Large Lower Anterior Facial Height

Control of the height of posterior dentoalveolar regions is of great importance for the correction of skeletal open bite. Traditionally, second premolar extraction facilitates the closure of open bite by inducing a counterclockwise mandibular rotation without molar intrusion. This article reports treatment for a 24-year six-month-old female patient with an open bite and large anterior facial height. She complained of occlusal disturbances and difficulty of lip closure because of the open bite. Overjet and overbite were +3.0 mm and -3.0 mm, respectively. To correct open bite and crowding, the bilateral extraction of the maxillary and mandibular second premolars plus multibracket appliances for mesial movement of the molars was selected as the treatment plan. After a two-year treatment, an acceptable occlusion was achieved, the lower anterior facial height was decreased, and the lips showed less tension in a lip closure. An acceptable occlusion was maintained without recurrence of the open bite during a three-year retention period, indicating a long-term stability of the occlusion. The results of this treatment indicated that the correction of open bite with no or less molar intrusion or incisor extrusion is of great importance for achieving stable occlusion and avoiding the relapse of open bite.

Expression of c-Fos-like immunoreactive neurons in the supratrigeminal region in the rat following noxious stimulation of the orofacial tissues.

This study was conducted to investigate immunohistochemically the expression of c-Fos in neurons around the trigeminal motor nucleus following application of mechanical force to a tooth, a mechanical pinch to the tongue, and paraformaldehyde injection into the periodontal ligament and masseter muscle. Following the application of all of these stimuli except pinching the tongue, a small number of c-Fos-like immunoreactive (Fos-LI) neurons were found in the ipsilateral supratrigeminal region. c-Fos expression was also detected in numerous neurons in the superficial laminae of the subnucleus caudalis in all experimental animals. Induction of c-Fos in the subnucleus caudalis and the supratrigeminal region indicates that Fos-LI neurons in the supratrigeminal region are involved in the processing of intraoral nociceptive signals.

An Adolescent Case of Anterior Open Bite with Masticatory Muscle Dysfunction

In adolescence an open bite is likely to be induced by various causes, and most patients with open bite show masticatory muscle dysfunction. The orthodontic correction of an open bite may lead to the recovery of harmonious stomatognathic function. This article reports treatment for a 12-year and 10-month-old female patient with an anterior open bite. She complained of occlusal disturbances due to an anterior open bite. Before the eruption of the upper second molars, she recognized the presence of occlusal contacts between the upper and lower anterior teeth. Before treatment, the activity of the masticatory muscles was relatively low during clenching. An upper lingual arch with an accessory spring to eliminate the premature contact and to improve the anterior open bite plus conventional fixed appliances for tooth alignment was selected as the treatment plan. Immediately after improvement of the open bite, the muscle activity became slightly greater than that at the initial stage. The total treatment time was 13 months. After treatment, an acceptable occlusion was achieved, the masticatory muscles were working harmoniously, and their activity was much higher than that at the initial stage. After a 2-year retention period, an acceptable occlusion was maintained without recurrence of the open bite, indicating a long-term stability of occlusion. The result of this treatment indicated that correction of open bite is of great importance for prevention of skeletal impairment and recovery of harmonious stomatognathic function lost by an unstable occlusion.