Vera Colombo

Stereometric Assessment of TMJ Space Variation by Occlusal Splints

Occlusal splints are used for the management of temporomandibular disorders, although their mechanism of action remains controversial. This study investigated whether insertion of an occlusal splint leads to condyle-fossa distance changes, and to mandibular rotation and/or translation. By combining magnetic resonance images with jaw tracking (dynamic stereometry), we analyzed the intra-articular distances of 20 human temporomandibular joints (TMJs) before and after insertion of occlusal splints of 3 mm thickness in the first molar region. For habitual closure, protrusion, and laterotrusion in the contralateral joint, occlusal splints led to minor—yet statistically significant—increases of global TMJ space and to larger increases at defined condylar areas. Condylar end rotation and translation in habitual closure were reduced. Hence, the insertion of a 3-mm-thick occlusal splint led to a change in the topographical condyle-fossa relationship, and therefore to a new distribution of contact areas between joint surfaces.

Relationship between Kinematic Center and TMJ Anatomy and Function

The kinematic center (KC)—defined by coinciding jaw-opening/-closing and protrusion-retrusion trajectories—has been proposed in the literature as a reference point to represent TMJ movements. In this study, we tested whether the KC lies in a peculiar anatomical point and whether its trajectory reflects intra-articular distance. In 11 asymptomatic individuals (seven females, four males, aged 24–37 yrs), 4 openings/closings and 4 protrusions/retrusions were tracked with dynamic stereometry. In a 3D lattice (0.5 mm grid) constructed solidly around each condyle, the KC was the point with maximal cross-correlation between opening-closing and protrusion-retrusion paths. KC trajectories were more cranial on closing than on opening, consistent with intra-articular distances being smaller on closing than on opening. However, KCs were never located on condylar main axes (distance, 4.5 ± 2.9 mm), nor did they coincide with points best approximating fossa shapes (distance, 12.5 ± 6.4 mm). The kinematic center’s anatomical and functional significance therefore appears to be questionable.

Temporomandibular Joint Loading Patterns Related to Joint Morphology: A Theoretical Study

It is unclear which aspects of the temporomandibular joint (TMJ) anatomy and/or kinematics determine shape and location of disk-compressive areas (stress field). The aim of this study was a quantitative analysis of TMJ anatomy to predict stress field path direction. Twenty-five asymptomatic TMJs (12 females and 13 males, aged 20–38 years) were tracked during unloaded opening/closing cycles. All TMJs were magnetic resonance (MR) imaged, reconstructed and animated with the recorded kinematics. Quantitative morphological parameters were calculated and entered into cross-validated multivariate discriminant analysis. Stress field paths during jaw opening were classified as mediolateral (ML) in 14 (9 females and 5 males) and lateromedial (LM) in 11 joints (3 females and 8 males). Curvature and incongruence as well as the dorsoventral position of the condyle in the fossa showed statistically significant differences (Mann-Whitney U test, p < 0.05). A combination of the lateral incongruence, the distance from the posterior slope of the eminence as well as the maximum posterior sagittal curvature enabled to correctly predict the direction of stress field paths in 92% of cases. In particular, ML type joints had laterally more congruent condyles/fossae and condyles more distant from the posterior slope of the eminence than LM type joints. Within the limits of this study, TMJ morphology seems to determine stress field path patterns.

Mechanical behavior of bovine nasal cartilage under static and dynamic loading

Abnormal mechanical loading may trigger cartilage degeneration associated with osteoarthritis. Tissue response to load has been the subject of several in vitro studies. However, simple stimuli were often applied, not fully mimicking the complex in vivo conditions. Therefore, a rolling/plowing explant test system (RPETS) was developed to replicate the combined in vivo loading patterns. In this work we investigated the mechanical behavior of bovine nasal septum (BNS) cartilage, selected as tissue approximation for experiments with RPETS, under static and dynamic loading. Biphasic material properties were determined and compared with those of other cartilaginous tissues. Furthermore, dynamic loading in plowing modality was performed to determine dynamic response and experimental results were compared with analytical models and Finite Elements (FE) computations. Results showed that BNS cartilage can be modeled as a biphasic material with Youngs modulus E=2.03 ± 0.7 MPa, aggregate modulus HA=2.35 ± 0.7 MPa, Poissons ratio ν=0.24 ± 0.07, and constant hydraulic permeability k0=3.0 ± 1.3 × 10(-15)m(4)(Ns)(-1). Furthermore, dynamic analysis showed that plowing induces macroscopic reactions in the tissue, proportionally to the applied loading force. The comparison among analytical, FE analysis and experimental results showed that predicted tangential forces and sample deformation lay in the range of variation of experimental results for one specific experimental condition. In conclusion, mechanical properties of BNS cartilage under both static and dynamic compression were assessed, showing that this tissue behave as a biphasic material and has a viscoelastic response to dynamic forces.

Design, construction and validation of a computer controlled system for functional loading of soft tissue

Osteoarthritis is a chronic degenerative disease affecting body joints. Abnormal mechanical loading could be an initiating factor of cartilage damage, by influencing chondrocytes activity. To date, devices performing mechanical studies of viable tissues are mostly uniaxial. In this work, we developed and validated a multi-axial device for static and dynamic mechanical testing of viable soft tissues. The system, named RPETS, is composed of a motor driven indenter, moving vertically and horizontally along the bottom of a tank containing tissue samples and it can apply combined compression, sliding, and rolling on viable samples. Validation studies were performed with standard rubber and bovine nasal cartilage tissue. Static tests demonstrated that the system is comparable to existing uniaxial devices, with a maximum force control error smaller than 0.5N and a positioning resolution of 5 μm. Dynamic tests performed with different motion profiles showed that the system can exert a load of 100N with a maximum velocity of 100mm/s maintaining the force control error within 10% of the desired value. Sinusoidal motion frequency can vary between 0.05 and 0.5Hz. In practical tests, viability staining of dynamically loaded cartilage slices showed extents of cell death to depend on the indenter velocity.

Alloplastic total temporomandibular joint replacements: do they perform like natural joints? Prospective cohort study with a historical control.

The aim of this study was to qualitatively and quantitatively describe the biomechanics of existing total alloplastic reconstructions of temporomandibular joints (TMJ). Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via dynamic stereometry technology. This non-invasive method combines three-dimensional imaging of the subjects anatomy with jaw tracking. It provides an insight into the patients jaw joint movements in real time and provides a quantitative evaluation. The patients were also evaluated clinically for jaw opening, protrusive and laterotrusive movements, pain, interference with eating, and satisfaction with the joint replacements. The qualitative assessment revealed that condyles of bilateral total joint replacements displayed similar basic motion patterns to those of unilateral prostheses. Quantitatively, mandibular movements of artificial joints during opening, protrusion, and laterotrusion were all significantly shorter than those of controls. A significantly restricted mandibular range of motion in replaced joints was also observed clinically. Fifty-three percent of patients suffered from chronic pain at rest and 67% reported reduced chewing function. Nonetheless, patients declared a high level of satisfaction with the replacement. This study shows that in order to gain a comprehensive understanding of complex therapeutic measures, a multidisciplinary approach is needed.

Coupling plowing of cartilage explants with gene expression in models for synovial joints

Articular cartilage undergoes complex loading modalities generally including sliding, rolling and plowing (i.e. the compression by a condyle normally to the tissue surface under simultaneously tangential displacement, thus generating a tractional force due to tissue deformation). Although in in vivo studies it was shown that excessive plowing can lead to osteoarthritis, little quantitative experimental work on this loading modality and its mechanobiological effects is available in the literature. Therefore, a rolling/plowing explant test system has been developed to study the effect on pristine cartilage of plowing at different perpendicular forces. Cartilage strips harvested from bovine nasal septa of 12-months-old calves were subjected for 2h to a plowing-regime with indenter normal force of 50 or 100 N and a sliding speed of 10 mm s(-1). 50 N produced a tractional force of 1.2±0.3N, whereas 100 N generated a tractional force of 8.0±1.4N. Furthermore, quantitative-real-time polymerase chain reaction experiments showed that TIMP-1 was 2.5x up-regulated after 50 N plowing and 2x after 100 N plowing, indicating an ongoing remodeling process. The expression of collagen type-I was not affected after 50 N plowing but it was up-regulated (6.6x) after 100 N plowing, suggesting a possible progression to an injury stage of the cartilage, as previously reported in cartilage of osteoarthritic patients. We conclude that plowing as performed by our mimetic system at the chosen experimental parameters induces changes in gene expression depending on the tractional force, which, in turn, relates to the applied normal force.

Displacement of teeth without and with bonded fixed orthodontic retainers: 3D analysis using triangular target frames and optoelectronic motion tracking device

PURPOSE The objective of this study was to evaluate the anterior tooth movement without and with bonded fixed orthodontic retainers under incremental loading conditions. MATERIALS AND METHODS Six extracted mandibular anterior human teeth were embedded in acrylic resin in True Form I Arch type and 3D reconstruction of Digital Volume Tomography (DVT) images (0.4 mm3 voxels) were obtained. The anatomy of each tooth was segmented and digitally reconstructed using 3D visualization software for medical images (AMIRA, FEI SVG). The digital models of the teeth were repositioned to form an arch with constant curvature using a CAD software (Rhinoceros) and a base holder was designed fitting the shape of the roots. The clearance between the roots and their slot in the holder was kept constant at 0.3 mm to replicate the periodontal ligament thickness. The holder and the teeth were then manufactured by 3D printing (Objet Eden 260VS, Stratasys) using a resin material for dental applications (E = 2-3 GPa). The 3D-printed teeth models were then positioned in the holder and the root compartments were filled with silicone. The procedure was repeated to obtain three identical arch models. Each model was tested for tooth mobility by applying force increasing from 5 to 30 N with 5 N increments applied perpendicular on the lingual tooth surface on the incisal one third (crosshead speed: 0.1 mm/s). The teeth on each model were first tested without retainer (control) and subsequently with the bonded retainers (braided bonded retainer wire; Multi-strand 1 × 3 high performance wire, 0.022″ × 0.016″). Tooth displacement was measured in terms of complicance (F/Δ movement) (N/mm) using custom-built optoelectronic motion tracking device (OPTIS) (accuracy: 5 µm; sampling rate: 200 Hz). The position of the object was detected through three LEDs positioned in a fixed triangular shape on a metal support (Triangular Target Frame). The measurements were repeated for three times for each tooth. Data were analyzed using mixed model with nesting (alpha = 0.05). RESULTS The use of retainer showed a significant effect on tooth mobility (0.008 ± 0.004) compared to non-bonded teeth (control) (0.014 ± 0.009) (p < 0.0001). The amount of displacement on the tooth basis was also significantly different (p = 0.0381) being the most for tooth no. 42 (without: 0.024 ± 0.01; with: 0.012 ± 0.002) (p = 0.0018). No significant difference was observed between repeated measurements (p = 0.097) and the incremental magnitude of loading (5-30 N: 0.07 ± 0.01-0.09 ± 0.02) (p > 0.05). CONCLUSION Mandibular anterior teeth showed less tooth mobility when bonded with stainless steel wire as opposed to non-bonded teeth but the tooth mobility varied depending on the tooth type. Intermittent increase in loading from 5 to 30 N did not increase tooth displacement.

Articular cartilage response to a sliding load using two different-sized spherical indenters

BACKGROUND Cartilage surface contact geometry influences the deformational behavior and stress distribution throughout the extracellular matrix (ECM) under load. OBJECTIVE To test the correlation between the mechanical and cellular response of articular cartilage when loaded with two different-sized spherical indenters under dynamic reciprocating sliding motion. METHODS Articular cartilage explants were subjected to a reciprocating sliding load using a 17.6 mm or 30.2 mm spherical ball for 2000 cycles at 10 mm/s and 4 kg axial load. Deformation of the cartilage was recorded and contact parameters were calculated according to Hertzian theory. After mechanical loading cartilage samples were collected and analyzed for ECM collagen damage, gene regulation and proteoglycan (PG) loss. RESULTS Significantly higher ECM deformation and strain and lower dynamic effective modulus were found for explants loaded with the smaller diameter indenter whereas contact radius and stress remained unaffected. Also, the 17.6 mm indenter increased PG loss and significantly upregulated genes for ECM proteins and enzymes as compared to the 30.2 mm indenter. CONCLUSION Sliding loads that increase ECM deformation/strain were found to induce enzyme-mediated catabolic processes in articular cartilage explants. These observations provide further understanding of how changes in cartilage contact mechanics under dynamic conditions can affect the cellular response.

Contents Vol. 187, 2008

Stem Cells and Tissue Engineering A. Bader, Leipzig E-Mail: augustinus.bader@bbz.uni-leipzig.de S.F. Badylak, Pittsburgh, Pa. E-Mail: badylaks@msx.upmc.edu A. Müller, Würzburg E-Mail: albrecht.müller@mail.uni-wuerzburg.de A. Ratcliffe, San Diego, Calif. E-Mail: anthonyratcliffe@synthasome.com A.M. Wobus, Gatersleben E-Mail: wobusam@ipk-gatersleben.de Neurosciences M. Frotscher, Freiburg i.Br. E-Mail: frotsch@sun2.ruf.uni-freiburg.de W.L. Neuhuber, Erlangen E-Mail: winfried.neuhuber@rzmail.uni-erlangen.de