Search

Counseling is considered a first-line conservative therapy with respect to temporomandibular joint disorders (TMJD). Nowadays, 50 to 80% of patients acquire health information from the internet before turning to professionals. The purpose of this study has been to investigate the quality of information about TMJD that patients can obtain from YouTube. A YouTube.com search was conducted using the terms “temporomandibular joint disorder”; “limited movement of the mandible”; and “mandibular joint pain”. The videos identified were assessed independently by two panels of three professional and lay reviewers with HONcode, modified DISCERN (MD) and the global quality scale (GQS). A total of 106 videos were included. The professional reviewers reported a mean HONcode score of 4.148 ± 1.314 and a mean MD score of 2.519 ± 1.267, testifying to a modest general quality of the videos. The mean GQS score was 2.987 ± 1.012 for the professional and 3.469 ± 0.891 for the lay reviewers (p < 0.001). The correlations between the ratings were significant between the reviewers within the same group but not between the two groups. The presence of animations significantly influenced the GQS score expressed by the lay reviewers (p = 0.011) but not that of the professionals (p = 0.640). The quality of the information on TMJD on YouTube is generally of poor quality. Healthcare systems and professionals should be prepared to correct misinformation and build trusting relationships with patients which are based on quality counseling. Similarly, academic institutions should produce quality content that leads patients with TMJD toward a correct diagnostic-therapeutic process.

Objective:In this study, we evaluated the pain and functional development of patients with internal derangements before and after discectomy.Materials and Methods:This was a retrospective cohort study in which patients with internal derangement underwent discectomy without replacement. The main primary variables were pre- and post-operative maximum mouth opening (MMO) and pain according to the Visual Analogue scale (VAS). Paired t-test was used to compare means to determine the differences between pre- and post-operative mouth opening and pre- and post-operative VAS.Results:Among the 20 patients included in this study, six and 14 underwent bilateral and unilateral discectomy without replacement, respectively. Paired sample t-test results revealed that there was a difference in MMO pre- and postoperatively, whereas the VAS scale showed no difference in terms of pain. According to the Wilkes classification, the difference between pre- and post-operative MMO of the patients was recorded. Based on these findings, no difference was observed between the mean pre- and post-operative MMOs of Wilkes stage III and IV patients, whereas a significant difference was found between Wilkes stage V and III patients (p0.05).Conclusion:In Wilkes stage III and IV subjects, discectomy without replacement is a good treatment option to relieve pain and improve functions in cases where conservative treatment fails.

Background: There is conflicting evidence regarding communication between the two compartments of the equine temporomandibular joint (TMJ). Understanding the inter-relationship between TMJ compartments is critical for diagnostic and clinical management purposes.Objective: To determine the frequency of communication between the discotemporal joint (DTJ) and the discomandibular joint (DMJ) of the equine TMJ in horses free of overt disease.Study Design: A randomized, blinded, controlled cadaveric study.Methods: Equine cadaver heads (n = 20), with no reported history of potential TMJ disease, were collected and stored frozen until use. Horses were randomized to the treatment group, such that Group A horses (n = 10) underwent arthrocentesis of the left DTJ and the right DMJ compartments, while Group B (n = 10) underwent arthrocentesis of the left DMJ and the right DTJ compartments of the TMJ, for a total of 40 joints. Computed tomography (CT) imaging was performed before, and after, intra-articular injection of contrast media in each head. Two observers, blinded to the treatment group, independently interpreted CT images.Results: Communication between synovial compartments occurred in the left TMJ of two horses. Arthroscopic evaluation revealed that both horses had a perforation of the intra-articular disc in the region of the caudomedial fibrous expansion. Mild anterior displacement of the abnormal disc in the joint of one horse was demonstrated using magnetic resonance imaging (MRI).Main Limitations: Sample size, the use of owner provided animals' history, and frozen specimens.Conclusions: No physiological communication was present between the DTJ and the DMJ in the equine TMJ of the cases studied, regardless of which compartment underwent arthrocentesis. Two joints had pathological communications. These results suggest that diagnostic, and medical, treatment of intra-articular disease may be most effective when both joint compartments are injected. Furthermore, this study illustrates the value of contrast enhancement while imaging the equine TMJ.

Internal derangement (ID) in the temporomandibular joint (TMJ) is defined as a mechanical problem of the joint that interferes with its function. It is attributed to an abnormal interaction among the articular disc, condyle, and joint eminence. The aim of this study is to evaluate diagnostic efficacy of non-invasive hand-carried ultrasonography instrumentation (US) to provide high-level images for a correct diagnosis of ID. Twenty-eight ID patients, 15 female and 13 males, were examined both clinically and by MRI images in order to achieve a diagnosis of ID (using Helkimo index). Then, they were submitted to US examination with a 12 MHz transducer by using hand-carried instrumentation by a clinician that was blind to their diagnosis and clinical data. TMJ US examination was performed with the mouth closed and mouth open, with proper technique. Each position was then evaluated with two different orientations of the transducer. US showed acceptable results in identifying bone structures. Lower values of diagnostic efficacy were obtained for disc position during joint movements with respect to MRI images. MRI still represents the gold standard for the identification of joint structures. If not corroborated by clinical and anamnestic data, the diagnostic efficacy of US in identifying the position of the disc during opening and closing jaw movements appears limited than compared to MRI.

Background/purpose Temporomandibular joint disc displacement is the most frequently reported temporomandibular disorder that may severely impair quality of life and can be challenging to treat. This study aimed to evaluate and compare the efficiency of intra-articular injection of injectable platelet rich fibrin (i-PRF) following arthrocentesis or arthrocentesis alone in treatment of patients with TMJ disc displacement with reduction. Materials and methods Forty patients for a total of forty joints with reducible anterior disc displacement, as confirmed by Magnetic Resonance Imaging (MRI) were selected and divided into 2 equal groups. In group I (control group), arthrocentesis alone was performed with Ringer solution. In group II (study group), a combination of arthrocentesis and intra-articular injection with 1.5 ml i-PRF was performed. The outcome variables included pain intensity evaluated with a visual analogue scale, inter-incisal opening, lateral movement evaluated in millimeters, and clicking. Assessments were done pre-operatively, and 1 week, 3 months, and 6 months postoperatively. Results There was statistically significant reduction in pain intensity and clicking sound and increase in mouth opening and lateral movement in i-PRF group when compared to arthrocentesis group. In addition, the differences between preoperative and postoperative status in all the measured parameters were statistically significant within the study and the control group throughout the postoperative period. Conclusion The combination of i-PRF with arthrocentesis is a safe and effective method in the treatment of TMJ disc displacement with reduction.

Temporomandibular joint disorders are a common cause of chronic musculoskeletal pain worldwide. Among these, internal disc derangement is the most frequent type of disorder. Internal derangement is defined as an abnormal positional and functional relationship between the disc and articulating surfaces. Common clinical symptoms include pain and clicking. Imaging plays a key role in diagnosing temporomandibular joint disorders. It is important for the radiologist to detect early imaging signs of internal derangement, thereby avoiding the evolution of this condition to degenerative joint disease. The aim of this article is to familiarise the reader with the spectrum of imaging findings that are encountered at different stages of the disease.

WOS: 000452890300002, PubMed: 30541231, Background/aim: Temporomandibular joint (TMJ) internal derangements consist of reduced and nonreduecd disc dislocations and are often diagnosed by magnetic resonance imaging (MRI). The main symptom of these derangements is TMJ pain. This study aimed to evaluate whether there is a correlation between TMJ pain and disc dislocation. Materials and methods: One hundred and four patients experiencing pain were evaluated retrospectively with the examination charts that we use routinely in our clinics and MRI. Patients were separated into two main groups as MRI(+) and MRI(-) groups according to their internal derangement findings in MRI. Mean VAS levels were compared between these two groups. Results: There were no significant differences between the MRI(+) and MRI(-) groups and no differences between the reduced disc dislocation group and nonreduced disc dislocation group. Conclusion: Although pain is maybe the most irritating symptom for TMJ patients, it cannot take the diagnostic place of MRI and MRI is still the gold standard method to make the exact diagnose of internal derangement.

OBJECTIVE: Arthroscopy of the temporomandibular joint (TMJ) has become a well-standardized non-invasive procedure for the treatment of TMJ internal derangement (ID). Since the last 1980s, no clinical application for arthroscopy of the inferior compartment has been established because of the intrinsic difficulty of the technique and the believing of the absence of clinical relevance for treatment of ID. METHODS: We report on a particular case in which arthroscopy of the inferior joint compartment together with the examination of the upper joint space was performed in a patient with ID of the TMJ. A 1.9 mm scope was used, while the technique for entering the inferior compartment is presented. RESULTS: The presence of intense synovitis, fibrous adhesion, and pseudowall were observed in the inferior joint compartment, thus leading to the hypothesis of the more than likely influence of the status of the synovial lining within this space in the persistence of symptoms in recalcitrant patients with ID. CONCLUSION: We believe that this new insight could lead surgeons to a more complete use of this non-invasive procedure for the treatment of this entity. LEVEL OF EVIDENCE: 4/5. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12663-017-1023-x) contains supplementary material, which is available to authorized users.

Background Although magnetic resonance imaging (MRI) helps to clearly visualize the disorders in temporomandibular joint (TMJ), the relationship between cross-sectional and clinical findings has not been precisely established. The aim of this study was to evaluate the relationship between clinical symptoms and MRI findings in individuals with TMJ pain. Material and Methods This cross-sectional study, conducted on the clinical and MRI findings of the patients, who applied to Uşak University, Oral and Maxillofacial Surgery Clinic with TMJ pain between the years 2016-2019. The primary predictor variables were MRI findings; disc position (normal, disc displacement with reduction (DDWR), disc displacement without reduction (DDWOR)), disc structural distortion (normal, folded, lengthened, round, biconvex, thick), condyle degeneration type (normal, moderate, severe) and joint effusion (JE) (absent, present). The primary outcome variable was pain, recorded on a visual analog scale (VAS) (numbered between 0-10). The other variables were demographic variables (age/gender). The relationship between clinical and MRI findings were statistically evaluated. The data were analysed by Kruskal Wallis and Mann Whitney U test. Chi-square (x2) test was used for categorical variable comparisons. P values

The number of patients diagnosed with temporomandibular joint (TMJ) internal derangements, who are seeking orthodontic treatment, is increasing. The aim of the study was to assess the relationship between the presence of TMJ reciprocal clicking and the morphology and position of the mandible, and position of lower incisors, examined on the lateral cephalograms. Fifty patients diagnosed with reciprocal clicking in at least one of the TMJs and 55 patients with no symptoms of TMJ dysfunction were included in the study. Cephalometric analysis was used for the assessment of: skeletal class, sagittal and vertical position of the mandible, angle of the mandible, inclination of the mandibular ramus and the mandibular corpus, as well as for the assessment of the position of the mandibular incisors. The statistical significance level was set at p = 0.05. There were no statistically significant differences between the examined groups regarding the sagittal and vertical position of the mandible, as well as regarding the sagittal position of the mandibular incisors. Presence of TMJ reciprocal clicking is not associated with the position and the morphology of the mandible, as well as with the sagittal position of the mandibular incisors. Patients with early stages of TMJ internal derangements do not present any significant changes in Cephalometrics. Patients diagnosed with TMJ internal derangements before orthodontic treatment require an interdisciplinary approach to the treatment, including physiotherapy.

This study aims to examine outcomes for temporomandibular joint (TMJ) arthroscopy in different Wilkes stages of internal derangement (ID) and factors relevant in relapse in those requiring further surgical management. A review was undertaken of patients who underwent TMJ arthroscopy from June 2017 until August 2019 at St George's Medical Centre, Christchurch, New Zealand. Those with a primary diagnosis of ID with adequate follow up were reviewed. Gender, pre-and post-operative visual analogue scale (VAS) pain scores and maximum incisal opening (MIO) according to Wilkes stages were statistically analysed. Parameters of those who underwent further surgery were assessed. Ninety-nine patients were reviewed with follow up time between 3 and 27 months. No difference in pre- and post-operative VAS pain scores occurred between Wilkes stages (p = 0.9527). Wilkes II patients had the lowest re-operation rates (6.7%). Twenty-one percent of patients underwent further surgery with either re-arthroscopy, arthrotomy or total joint replacement. Gender did not influence the risk of further surgery (p = 0.3451). Four Wilkes IV and 5 Wilkes V patients underwent TJR, with none from Wilkes II or III. This study shows TMJ arthroscopy should be considered a first line intervention in treating symptomatic ID regardless of initial Wilkes stage. A significant improvement in pain and functional levels occurred across all stages. No specific factors were identified for those undergoing further surgery. However, a trend towards open surgery and total joint replacement was seen in Wilkes IV and V patients.

SALMANOGLU, BERRIN/0000-0003-4344-5782 WOS: 000355236700008 PubMed: 25974819 The purposes of this study were to measure the activity of glutathione peroxidase (GPX) and nitric oxide (NO) in the synovial fluid of patients with temporomandibular joint (TMJ) internal derangement (ID) and to indicate the relationship between the activity of GPX and NO and the progress of the ID. Twenty-six patients with TMJ ID were identified and classified according to Wilkes staging through clinical and radiologic examinations. Levels of GPX were determined indirectly by a coupled reaction with glutathione reductase. Levels of NO were measured colorimetrically. The activity of GPX and NO was observed to be progressively increasing as the stage of the TMJ ID progressed. There were significant correlations between the 2 substances and the Wilkes stages. Oxidative stress may have a role in the pathogenesis of TMJ ID. In synovial fluid, GPX and NO activities are increased as the stage of the disease increased. Increase in the activities of GPX might not be enough to prevent progression of the TMJ ID.

WOS: 000346833400028 PubMed ID: 25491276 Background: Temporomandibular joint (TMJ) internal derangements are progressive painful conditions and cause joint dysfunction, joint sound, malocclusion, and locking of the mouth. Conservative and invasive techniques can be used for the treatment of TMJ internal derangements. The objective of the present study was to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis. Methods: Twenty patients (female: male; 15: 5; age 26, 3 +/- 9.3 years) for a total of 32 joints with reducible anterior disc dislocation, as confirmed by Magnetic Resonance Imaging (MRI), were divided into two groups. PRP was used for the study group, and arthrocentesis was used for the control group. Pain intensity, maximal interincisal opening, and TMJ sounds were assessed and compared for evaluation of treatment success. Results: There was a statistically significant reduction in pain intensity and joint sound and an increase in mouth opening in the study group when compared with the control group. Conclusions: This study shows that intra-articular PRP injection for the treatment of reducible disc displacement of the TMJ is a more effective method than arthrocentesis. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Objectives This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. Materials and Methods Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM (7 (OR, 11.25; P=0.039), and a maximum vertical opening of

Background: The terminology “temporomandibular disorders” (TMDs) encompasses a wide spectrum of conditions. Several hypothesized causes are occlusal disharmony, muscle hyperactivity, central pain mechanisms, psychological distress, and trauma. In day-to-day practice, TMDs had become more prevalent in Indian population due to changed dietary pattern and food habits, excessive stress of modern life, and other environmental causes. This study is an attempt to find the prevalence of TMDs in North Indian population. Aims: The present study is taken into account to determine the prevalence of TMDs on the basis of signs and symptoms based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Materials and Methods: The present cross-sectional study was conducted in the Department of Oral Medicine and Radiology. A total of 1009 patients aged between 6 and 80 years with a mean age of 42.04 ± 16.8 years seeking dental treatment from January 2016 to June 2017 were included in the study. All the patients were screened for TMD sign and symptoms. The demographic data and the signs and symptoms of TMDs were recorded in designed structured questionnaires which were based on the RDC/TMD criteria. Results: The study population consisted of 1009 patients aged between 6 and 80 years. In the present study population, based on RDC/TMD criteria, the incidence of clicking sound (42.5%) was highest in TMD joint followed by deviation of mandible on mouth opening (40.8%), internal derangement (36.8%), myofacial pain dysfunction syndrome (33.7%), osteoarthritis (29.5%), crepitus (25.8%), joint tenderness (5.8%), and pain on mouth opening (4.8%). Conclusion: Clicking sound was the most common sign of TMD disorders in Indian population.

Intra-Articular Temporo-Mandibular Disorders (TMD) are characterized by displacement of the disc that causes the condyles to slip back over the disc thus resulting in TMJ discal damage and erosion of the condyle's bone. The etiology of temporomandibular disorder (TMD) is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder. The study involved 46 joints in 27 patients with a diagnosis of Intra-Articular Temporo-Mandibular Disorders (TMD) according to Axis I of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications and underwent surgery between 2011 and 2014. Patients were divided into three groups. Group 1 were included patients with Disc Displacement (DD) without reduction without limited opening, Group 2 patients with DD without reduction with limited opening. Finally, Group 3 included patients with Degenerative Joint Disease (DJD) TMD. In all cases, diagnosis of Intra-Articular Temporo-Mandibular Disorders (TMD) was confirmed by pre-operative examination (clinical, MRI and/or CT scan). Tissue specimens were obtained from all 50 joints for histopathology. The aim of this study was to analyse histological features of the surgical specimens obtained from patients with Intra-Articular Temporo-Mandibular Disorders who underwent surgery and assess the association with clinical findings and imaging. Preliminary results show in Group 1, fibrocartilage is preserved and regular, there are isolated outbreaks of bone resorption and focal sclerosis. In Groups 2 and 3 fibrocartilages are irregular and thickness varies widely and sclerosis is more pronounced. In early stages of TMD, the disc antero-medial displacement might play a fundamental role in the etiopathogenesis that can became an irreversible joint damage thus leading to a wide spectrum of articular symptoms and signs in TMD (Cohen et al., 2014; Hagandora and Almarza, 2012; Nah, 2012).

Introduction: The articular eminence and condyle-fossa relationship reflects a secondary growth site and the morphology appears to be influenced by determinants of occlusal morphology which are subject to genetic variation of dentoalveolar bone metabolism. The Hypothesis: the articular eminence of the TMJ inclination is a function of sagittal, vertical and transverse determinants of occlusal morphology and therefore it may be possible to influence modeling of the articular eminence with orthodontic treatment at least in a transient way. Evaluation of the Hypothesis: The morphology of the articular eminence, dentoalveolar bone remodeling rates associated with IL-Beta and determinants of occlusal morphology are considered with respect to the etiology of articular disc displacement and internal derangement of the temporomandibular joint.

The temporomandibular joint disc is a structure, characterized as heterogeneous fibrocartilage, and is composed of macromolecular biopolymers. Despite a large body of characterization studies, the contribution of matrix biopolymers on the dynamic viscoelastic behavior of the disc is poorly understood. Given the high permeability and low concentration of glycosaminoglycans in the disc, it has been suggested that poro-elastic behavior can be neglected and that the intrinsic viscoelastic nature of solid matrix plays a dominant role in governing its time-dependent behavior. This study attempts to quantify the contribution of collagen and elastin fibers to the viscoelastic properties of the disc. Using collagenase and elastase, we perturbed the collagen and elastin fibrillar network in porcine temporomandibular joint discs and investigated the changes of dynamic viscoelastic properties in five different regions of the disc. Following both treatments, the storage and loss moduli of these regions were reduced dramatically up to the point that the tissue was no longer mechanically heterogeneous. However, the proportion of changes in storage and loss moduli were different for each treatment, reflected in the decrease and increase of the loss tangent for collagenase and elastase treated discs, respectively. The reduction of storage and loss moduli of the disc correlated with a decrease of biopolymer length. The present study indicates that the compositional and structural changes of collagen and elastin fibers alter the viscoelastic properties of the disc consistent with polymer dynamics.

OBJECTIVES:: To present a method for image fusion of cone beam CT (CBCT)/CT and MRI and to explore whether the image data sets fused in such a way could aid the detection of temporomandibular joint (TMJ) anatomical structures and lesions. METHODS:: There were five cases included in this study. One case was space occupying lesion giant cell tumour of tendon sheaths, one case was chronic inflammation in the condyle, one case was articular disc calcification of the bilateral TMJs, and the other two cases were TMJ disorders (anterior disc displacement without reduction). The digital imaging and communications in medicine format data of CT/CBCT and MRI of the cases were collected, and then imported to the Amira visual software where the registration process was conducted. Based on the different scan model, the registration process could be separated into automatic registration of CT/CBCT with quadrature slice MR images and the semi-automatic registration of CT/CBCT with oblique slice MR images by altering the registration parameters. Rigid transform model and the similarity metric of normalization mutual information was used for registration in the present study. RESULTS:: The relationship between the soft mass and hard tissue was shown clearly in the fused images when compared to sole observation of CBCT/CT or MR images. The fused images could define the tumour outline and the destructive bone clearly in the same image. The fused results helped the observers to ensure uncertain defects which could not be confirmed only by one image data set. CONCLUSIONS:: The CT/CBCT and MR images could be fused to aid detection of TMJ anatomical structures and related lesions. ispartof: DENTOMAXILLOFACIAL RADIOLOGY vol:48 issue:3 ispartof: location:England status: published

OBJECTIVE The purpose of this study was to assess the outcomes of temporomandibular joint (TMJ) "functional arthroplasty" on the inferior compartment and disc reposition as a surgical treatment for internal derangement (ID). PATIENTS AND METHODS By retrospective chart review, all patients who had TMJ surgery on the inferior compartment for TMJ ID from 1985 to 2010 were identified. Their charts were reviewed and subjective data as well as objective data was collected. RESULTS The chart review yielded 352 patients treated through this approach for a total of 696 joints involved. Analysis of the data showed that there was a good health improvement. The mid VAS about pre surgical TMJ pain was 58.3, after surgery 7.7. About headache and cervical pain the pre surgery mid VAS was 47.7, after surgery 16.7. CONCLUSIONS Outcome data presented show that TMJ surgery on the inferior compartment and disc reposition could be an effective and successful surgical treatment of TMJ ID. This success has been seen and maintained also in long term follow up in this specific patient population. For this reason, we propose to call this procedure "functional arthroplasty".

We examined the bone components of the temporomandibular joint (TMJ) in asymptomatic individuals and patients with temporomandibular dysfunction (TMD) using cone-beam computed tomography (CBCT). Two hundred asymptomatic individuals and 200 patients with TMD were included in this study. Condyle position, eminence height, eminence inclination, condyle shape, and fossa shape were assessed on CBCT images of the 800 temporomandibular joints. The eminence inclination (P < 0.05), eminence height (P < 0.0001), mediolateral width of condyle (P < 0.0001), and anterior joint space (P < 0.0001) were significantly greater in male subjects compared with female subjects in both the asymptomatic group and TMD group. Comparisons of the asymptomatic group and TMD group revealed significant differences in the anterior joint space (P < 0.0001), ratio of anterior joint space to posterior joint space (P < 0.001), posterior joint space (P < 0.05), eminence inclination (P < 0.05), eminence height (P < 0.05), condyle shape (P < 0.0001), and fossa shape (P < 0.05). The present analyses suggest that a steeper articular eminence inclination may be risk factor for TMD. The presence of TMD was associated with the condyle position in the TMJ.

Purpose To determine the correlation between dynamic Magnetic Resonance Imaging (MRI) and arthroscopy findings in internal derangement of the temporo-mandibular joint (TMJ). Material and methods This study was conducted on 25 patients (of 28 TMJs), 18 females and 7 males their age ranging from 20 to 42 years (mean 31 years). All patients were submitted to MRI examination of the TMJ. All of these patients underwent arthroscopy for diagnosis and treatment and results were compared with dynamic MRI findings. Results Concerning disc position, MR examination revealed 24 TMJs out of 28 (85.7%) with anteriorly displaced discs, while 4 TMJs (15.3%) showed normal disc position. When type of displacement was considered, MRI revealed 8 TMJs (28.7%) with anterior disc displacement with reduction (ADDWR), while 16 TMJs (57.1%) with anterior disc displacement without reduction (ADDWOR). While arthroscopy revealed 6 TMJs out of 28 (21.4%) with ADDWR, 14 TMJs (50%) showed ADDWOR and 8 TMJs (28.6%) with normal disc position. MRI assessment of disc mobility revealed 12 out of 28 TMJs (42.8%) with limited asynchronous movements, while 3 TMJs (10.7%) with stuck disc, and 13 TMJs (46.4%) with normal mobility. While arthroscopy revealed 11 out of 28 TMJs (39.2%) with limited disc mobility, 1 TMJs (3.5%) with stuck disc, and 16 TMJs (57.1%) with normal mobility. The results of this study showed no significant statistical difference between arthroscopy and MRI in diagnosing disc position and disc mobility. Conclusions Both arthroscopy and dynamic MRI are statistically correlated with each other in detecting TMJ internal derangement. Nevertheless, reviewing the results highlighted the advantages of MRI augmented by dynamic protocol over arthroscopy in diagnosing disc position and mobility and hence, we recommend using MRI as a first line diagnostic modality when internal derangement is suspected.

Aims and Objectives: To study the efficacy of MRI in assessing the disk position in clinically diagnosed patients of TMJ, Disk Displacement with Reduction and Disk Displacement without Reduction, and also compare the MRI findings between a control group and patients with Disk Displacement. Materials and Methods: Magnetic Resonance Imaging (MRI) was performed on a total of 16 clinically diagnosed patients of Internal Derangement of the TMJ, 13 of whom were diagnosed with Disk Displacement with Reduction, and the remaining 3 were diagnosed with Disk Displacement without Reduction. 6 asymptomatic volunteers formed the Control Group. The selected patients were then made to undergo an MRI Scan of the TMJ using a 1.5 Tesla MRI Scanner. The MRI scans were evaluated by a radiologist who was unaware of the clinical findings of the patients who were being included in the study. Statistical Analysis Used: Chi square test. Result: Of the total of 3 diagnosed patients of ADDWOR, MRI detected it in 2 cases and thus detection of MRI being 66.7%. Similarly, of the total 13 patients diagnosed with ADDWR, MRI detected it in 10 and thus detection of MRI being 71.4%. Comparing the frequency of detection between the two procedures, χ2 test revealed similar detection between the two procedures (χ2 = 0.03, P =0.870). To test the reliability (reproducibility) of MRI findings, the findings were also performed on 6 controls. Comparing the frequency of MRI findings between the two groups, χ2 test revealed similar visualization in both groups {83.3% (in Control) vs. 70.6% (in patients), χ2 = 0.37, P = 0.541}. Conclusion: There is a high similarity between the Clinical and the Radiological Diagnosis by using MRI as the investigative modality, and thus MRI is considered one of the most efficient modality for assessing the articular disk in Temporomandibular Joints.

Purpose: The aim of the present study was to evaluate the efficacy of arthrocentesis with and without sodium hyaluronate (SH) injection in the treatment of patients with temporomandibular joint (TMJ) internal derangement. Materials and Methods: The study consisted of 20 patients with chief complaints of limited mouth opening, TMJ pain, and jaw deviation. Patients with disc displacement with reduction and closed lock were randomly divided into two groups. In Group 1, only arthrocentesis was performed, and in Group 2, arthrocentesis plus intra-articular injection of SH was performed. Arthrocentesis was performed under aseptic conditions using normal saline. Clinical evaluation was done for maximum mouth opening (MMO), TMJ pain, and jaw deviation before the procedure and 1 week, 2 weeks, 1 month, and 3 months following arthrocentesis. Results: The mean visual analog scale (VAS) score change was statistically significant in Group 1 and Group 2 for within the group analysis. There was statistically significant difference in VAS score between Group 1 and Group 2 at all time intervals postoperatively. The increase in MMO from preoperative to 3 months postoperatively was statistically significant for within the group analysis. There was a reduction in mandibular deviation in both Group 1 and Group 2, but the difference was not statistically significant. There was no statistically significant difference in deviation between the two groups. Conclusion: Arthrocentesis with SH is superior to arthrocentesis alone in treating patients suffering with TMJ internal derangement, who are refractory to conservative treatment.

Kastelein M, Luijsterburg PA, Wagemakers HP, Bansraj SC, Berger MY, Koes BW, Bierma-Zeinstra SM. Diagnostic value of history taking and physical examination to assess effusion of the knee in traumatic knee patients in general practice. Objective To assess the diagnostic value of history taking and physical examination for knee joint effusion in patients with a knee injury who consult their general practitioner (GP). In addition, to determine the association between effusion seen on magnetic resonance imaging (MRI) and internal derangement of the knee. Design Prospective, observational cohort study. Setting Primary care. Participants Patients (N=134) aged 18 to 65 years with a traumatic knee injury who consulted their GP. Interventions Not applicable. Main Outcome Measures Patients filled out a questionnaire, underwent a standardized physical examination and underwent an MRI scan to assess the presence of effusion. Multivariate logistic regression analysis was used to determine the diagnostic value of history taking and physical examination ( P Results Of the 134 participating patients, 42 had knee joint effusion seen on MRI. Multivariate analysis showed an association with knee joint effusion for the symptom "self-noticed swelling" (history taking) and for the "ballottement test" (physical examination). The likelihood ratio positive (LR+) was 1.5 for self-noticed swelling and 1.6 for the ballottement test. These 2 combined improved the diagnostic value to an LR+ of 3.6. Effusion showed a positive association with internal derangement of the knee (chi-square 9.5); 31 of the 42 patients with knee joint effusion had internal derangement of the knee. Conclusions In patients with traumatic knee injury, knee joint effusion is frequently seen on MRI. The combination of self-noticed swelling and the ballottement test was of diagnostic value. Knee joint effusion was associated with internal derangement of the knee.

The purpose of this retrospective study was to define the accuracy of sonographic examination compared with magnetic resonance imaging (MRI) in detecting tears of the posterior cruciate ligament (PCL). Thirty-five patients with traumatic knee injuries fulfilling all the criteria were selected from 531 patients referred for sonographic examinations during 2003 to 2005 in the university hospital. The presence or absence of PCL injury was determined by MRI. Torn PCL was indicated when a PCL diameter (anterior-posterior dimension) greater than 10 mm, or a wavy or indistinct posterior PCL margin was found on sonographic examination. Among the 35 patients, 13 were found to have PCL tears on sonographic examination. Ten of these tears were also diagnosed by MRI. Two of 22 patients with normal PCL on sonographic examination were found to have PCL tears following MRI. There was significant agreement between MRI and sonography. We found that sonographic examination could accurately detect tears of the PCL and can be utilized as the first choice of imaging modality for patients with PCL injuries.

Introduction: Temperomandibular joint (TMJ) is subjected to many disorders commonly called Temperomandibular disorders (TMDs); such as TMJ hypermobility, ankylosis, internal derangement, degenerative joint disease. Internal derangement is characterized by abnormal relationship of articular disc to the condyle and disc to fossa. In past many non-invasive conservative treatment modalities were tried out for its treatment which are joint unloading, use of anti-inflammatory agents, physiotherapy etc. Now a days corticosteroids and platelet rich plasma (PRP) has been proposed as an alternative therapeutic agent. We aimed to assess whether intra articular injection of PRP in TMJ minimises the symptoms of internal derangements as compared to injection of hydrocortisone with local anaesthetic. Materials and Methods: Twenty patients for a total of 32 joints with reducible anterior disc location were divided in two groups. One group received PRP injection and the other received hydrocortisone with local anaesthetic for arthroscopy in their affected joints. Both patients and operator were blinded to the contents of injections. The patients were assessed for pain, maximum inter-incisal mouth opening and TMJ sound. Results: In the group of PRP injection, pain was markedly reduced than the group of hydrocortisone with local anesthetic; mouth opening was increased similarly in both groups and TMJ sound was experienced lesser in patients who received PRP. Conclusion: Injections of PRP were more effective in reducing the symptoms, as compared to hydrocortisone with local anaesthetics.

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 Ok 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.

Internal derangement (ID) in the temporomandibular joint (TMJ) compromises a group of clinical problems, and holds a relative high prevalence in populations. However, the temporal genomic change in gene expression of condylar cartilage during continuous ID remains unclear. Here we reported the differentially expressed gene pattern in condylar cartilage of rabbits with ID from 1 to 8 weeks by microarray analysis. The whole genome project was deposited at GenBank under the accession PRJNA278127. The microarray analysis showed that 6478 genes have more than two-fold changes among all the tested transcripts. Many inflammation gene increased rapidly in the early stage while decrease later. On the contrary, the bone construction related genes showed a low level at first and increased at later period in the ID progression. Besides, the current study found some genes such as HLA2G, which had never been reported, might be relevant with ID.

This cross-sectional study was designed to find out the effect of arthrocentesis with injection hyaluronic acid in the treatment of internal derangement of temporomandibular joint (TMJ ID) for the restoration of TMJ function. The study included 25 patients, aged 13 to 50 years with symptoms of TMJ pain and clicking during function and limited mouth opening. TMJ ID was assessed with clinical examination and conformed with MRI. Arthrocentesis was done with insertion of two 21gauze needles in the upper joint compartment and joint lavaged with 200 ml of ringer’s lactate solution and at the end 1ml of hyaluronic acid was injected. Intensity of TMJ pain and clicking was assessed using visual analog scale, maximum mouth opening, lateral jaw movement and protrusion were assessed with millimeter scale. All the parameters were measured before the procedure , immediately after the procedure then after 2 weeks, 1 month , 3 months and 6 months procedure. During 6 months follow-up, clinical examination and comparison of the results showed 84% reduction in TMJ pain, 92% improvement in mouth opening and clicking disappear in 80% of patients. Key words: TMJ pain; clicking; internal derangement; arthrocentesis; hyaluronic acid. DOI: 10.3329/bsmmuj.v3i1.5509 BSMMU J 2010; 3(1): 18-22

Ziel: Die bildgebende Diagnostik des Temporomandibulargelenkes (TMJ) mit der MRT ist bereits seit einigen Jahren eine etablierte Methode zur Diagnostik von Funktionsstörungen und degenerativen Veränderungen des Kiefergelenkes. Ziel der Untersuchung war es, an einem großen Kollektiv von Patienten mit „internal derangement“ (ID) anhand der MRT die verschiedenen in der Literatur beschriebenen morphometrischen Parameter mit dem Funktionszustand des Diskus zu vergleichen. Methodik: In einer retrospektiven Analyse wurden die MRT-Untersuchungen von 184 Patienten mit 320 auswertbaren Kiefergelenken analysiert, die wegen des Verdachtes auf ein „internal derangement“ eine hochauflösende MRT des Kiefergelenkes bei 1,5 T erhalten hatten. Die Bildanalyse umfasste neben der Beurteilung anatomischer Strukturen eine Vielzahl in der Literatur verwendeter morphometrischer Parameter. Diese Parameter wurden mit der Diskuslage verglichen. Ergebnisse: Anhand der vereinfachten Klassifikation nach Drace wurde die Diskuslage in „normal“ (NDP, 21,9%, n = 70), „anterior verlagert mit Reposition nach Mundöffnung“ (DVMR, 51,6%, n = 165) und „anterior verlagert ohne Reposition nach Mundöffnung“ (DVOR, 26,6%, n = 85) unterteilt. Mit zunehmender Diskusverlagerung fand sich eine signifikante Abnahme der Diskuslänge sowie der Dicke des anterioren und posterioren Bandes bei gleichzeitiger Zunahme der Breite der intermediären Zone des Diskus. Mit einer Diskusverlagerung waren Veränderungen des Condylus assoziiert, welcher eine zunehmende Entrundung sowie weitere degenerative Veränderungen aufwies. Als prädisponierender Faktor bei der Entstehung eines ID ist ein großes Tuberkulum und ein großer Tuberneigungswinkel anzusehen. Die Lage des Condylus änderte sich mit zunehmendem Grad des ID von einer konzentrischen Lage des Condylus-Mittelpunktes zu einer exzentrischen Position (dorsal und kranial). Bezüglich der Form der Fossa articularis fand sich kein statistischer Zusammenhang mit der Diskuslage. Schlussfolgerung: Mit der MRT ist möglich, sowohl Veränderungen der Weichgewebe als auch der knöchernen Strukturen bei Patienten mit internal derangement des Kiefergelenkes zu diagnostizieren und morphometrische Daten zu erheben., Purpose: To compare several morphometric parameters in MRI with the functional status of the articular disc in a large patient group suffering from internal derangement (ID) on the temporomandibular joint (TMJ). Materials and Methods: In a retrospective study, 320 analyzable high resolution MRI examinations of the TMJs obtained in a 1,5 T unit were evaluated in 184 patients with clinically suspected ID. The analysis included the anatomical structures and a number of morphometric parameters previously described in the literature. The parameters were compared with the position of the articular disc. Results: The disc position was categorized as „normal“ (NDP, 21,9%, n = 70), „anterior displacement with reduction on opening“ (DVMR, 51,6%, n = 165) and „anterior displacement without reduction on opening“ (DVOR, 26,6%, n = 85). With increasing disc displacement, significant configurational changes of the disc were observed. Disc displacement was associated with changes of the condyle consisting of increasing deformity and other degenerative changes. A large tuberculum and marked inclination of the eminence can be seen as predisposition for the development of ID. With increasing severity of the ID, the position of the condyle moved from a central position of the condylar center to an excentric (dorsal and cranial) position. Conclusion: MRI demonstrated that increasing disc displacement is associated with changes of disc, condyles and the condylar position in the fossa.

Introduction: Arthroscopy of the temporomandibular joint (TMJ) is a valuable diagnostic and therapeutic tool for various intra-articular disorders, especially internal derangement (ID) of the TMJ. Objectives: To evaluate the efficacy and safety of a standardized arthroscopic procedure for the treatment of two stages of ID; early/intermediate stage and intermediate/late stage. Materials and Methods: Retrospective analysis of medical records of 78 patients (99 joints) treated by arthroscopic lysis and lavage in the authors’ department during a 5-year period. Patients were diagnosed preoperatively as suffering from ID of the TMJ. The results were stratified according to the stage of ID. Three outcome variables were used to assess efficacy of treatment: Maximal interincisal opening (MIO), level of pain on a visual analog scale (VAS), and frequency of intermittent locking episodes. In addition, complications were reported. Results: Mean MIO of the group of patients with intermediate/late stage ID increased from 27 ± 4.7 mm preoperatively to 38 ± 5.4 mm postoperatively (P < 0.0001). For the group of patients with early/intermediate stage ID, mean MIO did not change significantly after arthroscopy (39.1 ± 6.2 mm compared to 41.4 ± 5 mm, P = 0.06), however, subjective evaluation of pain on a VAS decreased from 7.2 ± 1.2 preoperatively to 3.4 ± 2.2 postoperatively (P < 0.0001), and 80% of the patients (25 of 31) denied experiencing intermittent locking episodes after treatment (P < 0.0001). Conclusion: Arthroscopic lysis and lavage is a safe and effective therapeutic modality for the treatment of both mild and advanced stages of ID.

This case report describes the orthodontic treatment performed for open bite caused by internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). A Japanese woman, aged 31 years and 11 months, referred to our department by an oral surgeon had an open bite with clockwise rotation of the mandible and degeneration of the condyle. The overbite was corrected through intrusion of the maxillary and mandibular molars using mini-screw implants to induce counterclockwise rotation of the mandible. Then, the mandibular second premolars were extracted and comprehensive orthodontic treatment was performed to establish a Class I molar relationship with distalization of the maxillary arch and to eliminate anterior crowding. Following treatment, her facial profile improved and a functional and stable occlusion was achieved without recurrence of the TMJ symptoms. These results suggest that orthodontic intrusion of the molars is one of the safer and less stressful alternatives for the management of open bite due to degeneration of the condyles caused by ID and OA of TMJ.

The aim of this thesis was to evaluate the indications for and the results of temporomandibular joint (TMJ) surgery in patients with long-standing severe orofacial pain and dysfunction as well as in patients with fractures of the condylar neck. The patients with long-standing pain and dysfunction had had symptoms for a mean time of 4 years, had been treated conservatively for a mean time of 2.5 years, and had undergone numerous conservative treatment methods without improvement except for a minor increase in mouth opening capacity.The indications for surgery were strict; only 1% or less of all the patients referred to the departments with a diagnosis of temporomandibular disorder (TMD) were prescribed surgery, which was considered to be the only remaining option. The TMJ surgery reduced pain, sleeping problems, and analgesic consumption and improved mouth opening capacity. The procedure showed low morbidity except for a facial nerve disturbance in three patients.Postoperatively, the bite force was observed to be normalised, and the radiographic examination showed moderate to severe osteoarthrotic changes. These changes, though extensive, were considered to be the normal outcome of diskectomy and without clinical significance, even though they resembled degenerative joint disease. In study V, surgery was performed on patients with a clear diagnosis of anterior disk displacement (ADD) with or without reduction. The preoperative pain and mouth opening capacity were markedly improved as well as other subjective symptoms. Although surgical morbidity was low, some radiographic changes were clearly detectable. In agreement with earlier reports, patients with a distinct diagnosis of ADD with or without reduction were clearly helped by diskectomy.In cases of ADD with or without reduction, it can be concluded that unsuccessful conservative treatment should not exceed 3 6 months but be discontinued in favour of the documented advantages of surgery in these cases. Patients with ankylosis should be treated surgically without delay. Unclear diagnoses such as arthralgia and osteoarthrosis with symptoms should be excluded from surgery unless overlapping muscular hyperactivity has been excluded as a major cause of the patients problem. Diskectomy is a useful surgical procedure for patients with severe long-standing TMD. It was shown in study VI that patients with dislocated fractures of the condylar neck can be successfully treated with open surgical reduction when the dislocation is large and associated with symptoms and limited function.When cognitive-behavioural profiles were measured psychometrically in study VII, a dysfunctional profile was more common in patients with myofascial pain and pain with an obscure origin than in other patients diagnosed with TMD. The dysfunctional profile was also common in patients in whom treatment of a conservative or surgical nature had failed. Among TMD patients with disk displacement, adaptive copers were most common in successfully diskectomized patients and least common in patients about to undergo invasive treatment.

Internal derangement is the most common pathological condition affecting the temporomandibular joint (TMJ). Magnetic resonance imaging (MRI) of TMJ is principally directed toward assessment of the soft-tissue abnormalities in terms of internal derangement. This pedagogical article describes anatomy and biomechanics and provides a pictorial overview of the MRI findings of the disc abnormalities of TMJ.

The present study aimed at investigating the expression of a hyaluronan synthase (HAS) 3 in tissue samples of deformed human temporomandibular joint (TMJ) discs and cells obtained from the discs. Fifteen adult human TMJ discs (twelve diseased discs and three normal discs) were used in this study. The twelve diseased discs were obtained from twelve patients with internal derangement (ID) of TMJ. These patients all had anteriorly displaced discs and deformed discs. The tissues were immunohistochemically stained using HAS3 antibodies. In addition, the subcultured TMJ disc cells under both normal and hypoxic conditions (O2: 2%) were incubated for 3, 6, 12, and 24 h after addition of interleukin-1ß (IL-1ß) (1ng/mL). Subsequently, the expression of HAS3 was examined using real-time reverse transcription-polymerase chain reaction (RT-PCR). The control group showed from negative to weak positive reactions for HAS3 on immunohistochemical staining. The discs extracted from twelve cases with ID presented from moderate to strong positive reactions for HAS3. The quantity of HAS3 mRNA was compared with a control group, and showed a 204-fold increase at 3 h, a 26-fold increase at 6 h, a 2.5-fold increase at 12 h and a 32-fold increase at 24 h under hypoxia with the addition of IL-1ß. The expression of HAS3 mRNA was significantly enhanced at 3 h and 24 h. The results obtained suggest that HAS3 is related to the pathological changes of human TMJ discs affected by ID.

Heat shock proteins (HSPs) are believed to represent a cellular stress response mechanism that protects intracellular proteins from damaging events. Some studies have demonstrated an enhanced expression of large-molecular-weight HSPs in diseased systematic joints. Small heat shock proteins, and among these HSP27, have been studied to a lesser extent. HSP27 has cytoprotective and biosynthetic functions within chondrocytes, and it is an estrogen-associated protein that is under hormonal modulation. To improve understanding at a molecular level of the pathophysiology of certain temporomandibular joint disorders, the authors carried out this immunohistochemical study to assess the presence of HSP27 in human TMJ discs. Twelve adult human TMJ discs (10 diseased and 2 healthy discs) and 5 TMJ fetal human discs were used in this study. Adult discs and TMJ tissues of human fetuses were fixed in 10% buffered formalin. Samples were then processed for histologic examination. Sections were immunohistochemically stained using the streptavidin-biotin detection method. No reaction product for HSP27 in the discs of fetuses was noted. HSP27 was weakly expressed in normal TMJ discs and highly up-regulated in discs of patients showing new vessel formation and chondroid metaplasia. Any correlation between gender and HSP27 was found in the sample, being the up-regulation of HSP27 related mostly to major histopathological changes. This different pattern of HSP27 immunostaining in human TMJ discs detected in the authors' specimens suggests that the expression of this small HSP is functionally modulated. In fact HSP27 up-regulates in internal derangement specimens with major histopathological changes; on the other hand, it is not expressed or only weakly expressed in TMJ discs of fetuses and normal TMJ discs.

Temporomandibular joint internal derangement (TMJ ID) is characterised by disc displacement and degenerative tissue changes involving an active cellular response, with cell phenotype transformation from fibroblast-like to fibrochondrocyte and, eventually, to chondrocyte-like, possibly as a response to abnormal loading. However, only small patches of chondral tissue are detected in TMJ discs with ID. We decided to explore the reasons for such incomplete tissue change, postulating an involvement of the apoptosis process. Twenty-one discs removed from 19 patients with TMJ ID were processed for TRAIL and DR5 immunohistochemical localisation, and subjected to the TUNEL assay. Overexpression of DR5 receptor and its ligand (TRAIL) in chondrocyte-like cells suggested activation of programmed cell death, as also demonstrated by TUNEL-positive cells. The data suggest a failed adaptive response to disc displacement through chondroid metaplasia. The apoptotic death of chondrocyte-like cells, which is at least partly regulated by TRAIL and its death receptor, appears to underpin the failed disc repair, eventually leading to its perforation.

Internal derangement (ID) is among the most common disorders of the temporomandibular joint (TMJ). Previous research by our group highlighted a correlation between apoptosis and TMJ ID. Metalloproteinases (MMP)-7 and -9 have been shown to play an important role in extracellular matrix ECM) homeostasis and, through it, in joint disc remodelling. The immunohistochemical expression of MMP-7 and -9 was investigated in discs from patients with TMJ ID and from healthy donors and compared with the degree of histological tissue degeneration. The collagen fibre arrangement in pathological discs exhibited varying degrees of disruption. New vessels were consistently detected; endothelial cells from these vessels were immunolabelled with both MMP-7 and MMP-9. More or less intense MMP-7 and MMP-9 immunolabelling was detected in the cytoplasm of disc cells from all patients. MMP-7 and MMP-9 immunostaining was significantly different between pathological and normal discs and correlated with the extent of histopathological degeneration. MMP-7 and MMP-9 upregulation in discs from patients with TMJ ID demonstrates their involvement in disc damage in this disorder. A greater understanding of these processes could help identify ways to curb MMP overproduction without affecting their tissue remodelling action. The design of specific inhibitors for these MMPs would not only help to gain insights into the biological roles of MMPs, but would also aid in developing therapeutic interventions for diseases associated with abnormal ECM degradation.

Elderly patients suffer from various systemic diseases and are likely to neglect their problems with functional disorders in the masticatory system, which are of crucial importance for successful prosthetic treatment. The purpose of the study was to establish the frequency of symptoms, clinical signs and tissue-specific diagnoses of internal derangement of the temporomandibular joint in elderly subjects and their relation with respect to gender and type of prosthetic replacement. The study was conducted on 96 subjects, 48 complete denture wearers and 48 removable partial denture wearers, whose average age was 75.8 years. The diagnostic procedure used in this study was manual functional analysis consisting of specific techniques of dynamic compressions and translations in diagnosing internal derangement of the temporomandibular joint. Chi-square test for independent samples was used for statistical analysis of the results. The symptoms of internal derangement of the temporomandibular joint were found in 9.3% of the subjects, and tissue-specific diagnoses were established in 52.1% of the subjects. The most common diagnoses were osteoarthrosis, total disk displacement with stable reposition and partial anterolateral disk displacement. No statistically significant differences in the frequency of symptoms, clinical signs and tissue-specific diagnoses were found between genders (P>.05) and complete and removable partial denture wearers (P>.05). The frequency of subjective symptoms of internal derangement in the temporomandibular joint of elderly subjects was low in relation to the frequency of intracapsular tissue-specific diagnoses.