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Cureus Oct 2023Background This study aims to evaluate the accuracy of volumetric measurements of three-dimensional (3D)-printed human condyles from cone-beam computed tomography (CBCT)...
Appraisal of the Accuracy and Reliability of Cone-Beam Computed Tomography and Three-Dimensional Printing for Volumetric Mandibular Condyle Measurements of a Human Condyle.
Background This study aims to evaluate the accuracy of volumetric measurements of three-dimensional (3D)-printed human condyles from cone-beam computed tomography (CBCT) in comparison to physical condyles using a water displacement test. Methodology A sample of 22 dry condyles was separated from the mandibular body by disc, mounted on a base made of casting wax, and scanned using the SCANORA (Scanora 3DX, Soredex, Finland) CBCT scanner. Subsequently, the projection data were reconstructed with the machine-dedicated OnDemand 3D (Cybermed Co., Seoul, Korea). The Standard Tessellation Language file was prepared for 3D printing using chitubox slicing software v1.9.1. Frozen water-washable gray resin was used for 3D printing. All condyles were printed using the same parameters and the same resin. The volumetric measurements were then performed using a customized modified pycnometer based on water volume and weight displacement. Volumetric measures were performed for both the physical human condyles and the 3D-printed replicas and the measurements were then compared. Results The volume of dry condyles using the water displacement method showed an average (±SD) of 1.925 ± 0.40 cm. However, the volume of 3D-printed replicas using the water displacement method showed an average (±SD) of 2.109 ± 0.40 cm. The differences in measurements were insignificant (p > 0.05), as revealed by an independent t-test. Conclusions Highly precise, accurate, and reliable CBCT for volumetric mandibular condyle was applied for measurements of a human condyle and 3D-printed replica. The modified pycnometer for volumetric measurements presented an excellent volumetric measure based on a simple water displacement device. The tested modified pycnometer can be applied in volumetric measurements in both 3D-printed and mandibular condyle. For best accuracy, the highest scanning resolution possible should be used. As it directly handles irregularly shaped solid objects in a non-destructive manner with a high level of precision and reliability, this 3D scanning approach may be seen as a superior alternative to the current measurement methods.
PubMed: 38022326
DOI: 10.7759/cureus.46746 -
Journal of Neurological Surgery. Part... Feb 2024To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine...
To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine lesions. Five dry skulls were examined for surgical approach. Three adult cadaveric heads underwent bilateral dissection. One cadaveric head was evaluated with computed tomography after dissection. This study was performed in an academic medical center. Neurosurgical anatomy researchers performed this study using dry skulls and cadaveric heads. This was a proof-of-concept anatomical study. The mandibular fossa approach uses a vertical preauricular incision above the facial nerve branches. Removal of the temporomandibular joint exposes the mandibular fossa. The anterior boundary is the mandibular nerve at the foramen ovale, and the posterior boundary is the jugular foramen. The chorda tympani, eustachian tube, and tensor tympani muscle are sectioned. The carotid artery is transposed out of the petrous canal, and a petrosectomy is performed from Meckel's cave to the foramen magnum and anterior occipital condyle. Dural opening exposes the anterior pons, vertebrobasilar junction, bilateral vertebral arteries, and the ipsilateral anterior and posterior inferior cerebellar arteries. At completion, the temporomandibular joint is reconstructed with a prosthetic joint utilizing a second incision along the mandible. The mandibular fossa approach is a new trajectory to the petroclival region and the anterior pons. It combines the more anterior angle of endoscopic approaches along with the enhanced control of open approaches. Further study is necessary before this approach is used clinically.
PubMed: 38327513
DOI: 10.1055/s-0042-1759873 -
Journal of Orthopaedic Surgery and... Oct 2023Temporomandibular joint osteoarthritis (TMJOA) is a common disease that negatively affects the life quality of human beings. Circadian rhythm acts an important role in...
PURPOSE
Temporomandibular joint osteoarthritis (TMJOA) is a common disease that negatively affects the life quality of human beings. Circadian rhythm acts an important role in life activities. However, whether the clock genes are rhythmic expressed in mandibular condylar chondrocytes, or the clock genes have an effect on the progression of TMJOA remains unknown. In this study, we aim to explore expression of clock genes and regulatory mechanism of TMJOA in rat mandibular condylar chondrocytes.
METHODS
After synchronized by dexamethasone, the expression of core clock genes Per1, Per2, Clock, Cry1, Cry2 and Bmal1 and cartilage matrix degrading factor gene Mmp13 were analyzed in mandibular condylar chondrocytes every 4 h with RT-qPCR. The mandibular condylar chondrocytes were stimulated with IL-1β, and expression of Per1, Mmp13, P65 and p-P65 was assessed by RT-qPCR and Western blot. Sh-Per1 lentivirus was used to assess the effect of clock gene Per1 in IL-1β-induced chondrocytes, and expression of Mmp13, P65 and p-P65 was measured. After establishing a rat TMJOA model using unilateral anterior crossbite (UAC), micro-CT, H & E, Alcian Blue & Nuclear Fast Red and Safranin O & Fast Green, cartilage thickness was utilized to assess the damage of cartilage and subchondral bone. Immunohistochemistry of PER1, MMP13 and P65 was performed in condylar sections.
RESULTS
All core clock genes and Mmp13 were rhythmically expressed. And Mmp13 expression curve was closed in phase and amplitude with Per1. After stimulation with IL-1β, the expression of MMP13, PER1 and P65 and ratio of p-P65/P65 increased in condylar chondrocytes. After Per1 was down-regulated in condylar chondrocytes, the expression of MMP13 and P65 and ratio of p-P65/P65 decreased. Compared with the condyles of Sham group, the bony parameters of UAC group were significantly worse. The thickness of cartilage in UAC group significantly reduced. The modified Mankin scores and the expression of PER1, MMP13 and P65 in cartilage of UAC group significantly increased compared with Sham group.
CONCLUSION
Core clock genes and Mmp13 are rhythmic expressed in rat mandibular condylar chondrocytes. PER1 can regulate the expression of MMP13 through NF-κB pathway in IL-1β-induced mandibular condylar chondrocytes.
Topics: Animals; Rats; Chondrocytes; Mandibular Condyle; Matrix Metalloproteinase 13; NF-kappa B; Osteoarthritis; Period Circadian Proteins; Temporomandibular Joint
PubMed: 37907921
DOI: 10.1186/s13018-023-04301-7 -
Head & Face Medicine Dec 2023An accurate identification of mandibular asymmetries is required by modern orthodontics and orthognathic surgery to improve diagnosis and treatment planning of such... (Observational Study)
Observational Study
Three-dimensional quantification of mandibular asymmetries in Caucasian adult patients with different sagittal and vertical skeletal patterns. A cone beam study using 3D segmentation and mirroring procedures.
INTRODUCTION
An accurate identification of mandibular asymmetries is required by modern orthodontics and orthognathic surgery to improve diagnosis and treatment planning of such deformities. Although craniofacial deformities are very frequent pathologies, some types of asymmetries can be very difficult to assess without the proper diagnostic tools. The purpose of this study was to implement the usage of three-dimensional (3D) segmentation procedures to identify asymmetries at the mandibular level in adult patients with different vertical and sagittal patterns where the asymmetries could go unnoticed at the observational level.
METHODS
The study sample comprised 60 adult patients (33 women and 27 men, aged between 18 and 60 years). Subjects were divided into 3 sagittal and vertical skeletal groups. CBCT images were segmented, mirrored and voxel-based registered with reference landmarks using ITK-SNAP® and 3DSlicer® software's. 3D surface models were constructed to evaluate the degree of asymmetry at different anatomical levels.
RESULTS
There was a degree of asymmetry, with the left hemimandible tending to contain the right one (0.123 ± 0.270 mm (CI95% 0.036-0.222; p < 0.001). Although the subjects under study did not present significant differences between mandibular asymmetries and their sagittal or vertical skeletal pattern (p = 0.809 and p = 0.453, respectively), a statistically significant difference has been found depending on the anatomical region (p < 0.001; CI95%=1.020-1.021), being higher in the condyle, followed by the ramus and the corpus.
CONCLUSIONS
Although mandibular asymmetries cannot be correlated with vertical and sagittal skeletal patterns in symmetric patients, knowledge about 3D segmentation procedures and color maps can provide valuable information to identify mandibular asymmetries.
Topics: Adult; Male; Humans; Female; Adolescent; Young Adult; Middle Aged; Imaging, Three-Dimensional; Cone-Beam Computed Tomography; Facial Asymmetry; Mandible; Mandibular Condyle
PubMed: 38098053
DOI: 10.1186/s13005-023-00400-2 -
Oral and Maxillofacial Surgery Jun 2024The aim of this study is to analyze mandibular condyle position changes after bilateral sagittal split osteotomy (BSSO) and bimaxillary orthognathic surgery in patients...
PURPOSE
The aim of this study is to analyze mandibular condyle position changes after bilateral sagittal split osteotomy (BSSO) and bimaxillary orthognathic surgery in patients operated at a single department by two surgeons in 2013-2022. Compared were groups of mandibular advancement vs setback and bimaxillary vs BSSO.
METHODS
Ninety-nine subjects were included. Inclusion criteria were patients who underwent one of the BSSO or bimaxillary surgery and had CT scans performed before and after surgery. Preoperative CT scans were performed 1 day before surgery and postoperative CT scans 6-12 months afterwards. Changes in mandibular condyle position were measured in axial and sagittal planes.
RESULTS
CT condylar position measurements indicated significant postoperative changes in AB angle bilaterally (p = < 0.001). In mandibular advancement and setback comparison, values were significantly lower in ABL angle values in the setback group (p = 0.011326) and significantly higher in FDR in the advancement group (p = 0.005795). There were no statistically significant changes found in BSSO and bimaxillary group comparison.
CONCLUSION
Within the limitations of this study, it can be concluded that orthognathic surgery does have a moderate effect on position of the condyles, especially condylar rotation in transversal axis.
Topics: Humans; Mandibular Condyle; Retrospective Studies; Female; Male; Adult; Osteotomy, Sagittal Split Ramus; Orthognathic Surgical Procedures; Tomography, X-Ray Computed; Mandibular Advancement; Young Adult; Adolescent; Cephalometry
PubMed: 37740127
DOI: 10.1007/s10006-023-01181-3 -
Scientific Reports Mar 2024This study aimed to evaluate the association between single nucleotide polymorphisms (SNPs) in endochondral development-related genes and mandibular condyle shape, size,...
This study aimed to evaluate the association between single nucleotide polymorphisms (SNPs) in endochondral development-related genes and mandibular condyle shape, size, volume, and symmetry traits. Cone-beam Computed Tomographies and genomic DNA from 118 individuals were evaluated (age range: 15-66 years). Data from twelve 3D landmarks on mandibular condyles were submitted to morphometric analyses including Procrustes fit, principal component analysis, and estimation of centroid sizes and fluctuating asymmetry scores. Condylar volumes were additionally measured. Seven SNPs across BMP2, BMP4, RUNX2 and SMAD6 were genotyped. Linear models were fit to evaluate the effect of the SNPs on the mandibular condyles' quantitative traits. Only the association between BMP2 rs1005464 and centroid size remained significant after adjusting to account for the false discovery rate due to multiple testing. Individuals carrying at least one A allele for this SNP showed larger condylar size than common homozygotes GG (β = 0.043; 95% CI: 0.014-0.071; P value = 0.028). The model including BMP2 rs1005464, age and sex of the participants explained 17% of the variation in condylar size. Shape, volume, and symmetry were not associated with the evaluated SNPs. These results suggest that BMP2 rs1005464 might be associated with variation in the mandibular condyles size.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Mandibular Condyle; Cone-Beam Computed Tomography; Malocclusion; Alleles; Genotype; Bone Morphogenetic Protein 2
PubMed: 38472272
DOI: 10.1038/s41598-024-56530-3 -
Orthodontics & Craniofacial Research Nov 2023The aim of this cross-sectional study was to investigate maxillomandibular morphology in hyperdivergent and hypodivergent individuals, using 3D surface models generated...
INTRODUCTION
The aim of this cross-sectional study was to investigate maxillomandibular morphology in hyperdivergent and hypodivergent individuals, using 3D surface models generated by cone-beam computed tomography (CBCT).
METHODS
The sample consisted of 60 CBCTs (30 males, 30 females) patients aged 12-30 years, divided into two groups comprising hyperdivergent (≥35°) and hypodivergent (≤30°) individuals, according to the mandibular plane (MP) angle. Multiplanar reconstructions were used to mark the landmarks, and 3D surface models were created to evaluate structures of the maxillomandibular complex, including condyle, ramus, symphysis and palatal height. Intergroup comparisons were performed by independent t-test. Pearson's correlation test was used (P < .05) to evaluate the correlation of the MP angle with the angles and linear measurements of other structures.
RESULTS
Significant differences were found between the groups regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. No differences (P > .05) were found for the condylar height, symphysis inclination angle or palatal height. Correlations (P < .05) were found between the MP angle and structures of the maxillomandibular complex.
CONCLUSIONS
Hyperdivergent (MP ≥ 35°) and hypodivergent (MP ≤ 30°) individuals present different skeletal morphology regarding condylar width, ramus height, condylar plus ramus height, mandibular length, gonial angle, palatal plane angle and palatal-mandibular angle. There is a significant correlation between MP angle and morphological structures such as condyle, ramus, symphysis, palatal plane angle and palatal-mandibular angle.
Topics: Male; Female; Humans; Cross-Sectional Studies; Mandible; Cone-Beam Computed Tomography; Cephalometry; Mandibular Condyle
PubMed: 37246594
DOI: 10.1111/ocr.12677 -
Journal of Oral Biology and... 2023The temporomandibular joint (TMJ) is a synovial joint that allows the complex movements essential for life. It connects the jawbone to the skull, working as a sliding...
BACKGROUND AND AIM
The temporomandibular joint (TMJ) is a synovial joint that allows the complex movements essential for life. It connects the jawbone to the skull, working as a sliding hinge. Moreover, pluripotent stem cells are a source of precursors and tissue-specific cells in developing organisms, however, their biodistribution in developing fetal tissues is weakly studied. The aim of our study was analyse immunohistochemical expression of Nanog, Oct-4, Sox-2 and Stat-3 and Sox-5, in TMJ tissue samples from human fetuses aged between the 12th and 20th weeks of intrauterine life.
MATERIALS AND METHODS
We fixed and processed TMJ tissue samples from human fetuses, histological sections and immunohistochemical procedures were carried out.
RESULTS
TMJ histological studies examination did not reveal any difference in the tissue organization between the samples in the studied periods. Immunohistochemical analysis demonstrated that Oct-4 and Sox-2 lack their expression in TMJ. In contrast, Nanog was expressed in nucleous of proliferative layer of mandibular condyle, Stat-3 was expressed in nuclear cells of articular disc, Stat-3 and Sox-5 showed positive nuclear and cytoplasmic immunostaining in codrocyte layers and in ossification areas.
CONCLUSIONS
Nanog acts in maintanence of pluripotency, Stat-3 in articular disc acts as a transcriptional factor. Stat-3 and Sox-2 act in chondrocyte and osteoblast diferentiation. Distribution of the cells, which express Nanog, Stat-3, and Sox-5 in TMJ tissue during fetal development, can help further understand its physiology, pathology, and repairing capacities.
PubMed: 37637855
DOI: 10.1016/j.jobcr.2023.08.002 -
Quantitative Imaging in Medicine and... Apr 2024Although the application of vascularized free bone muscle flap to reconstruct the mandible has become a standardized approach for mandible reconstruction, the results of...
Poor condyle position after mandibular reconstruction and a classification system for patients with "VSCU" based on computed tomography: a cross-sectional study with retrospective data collection.
BACKGROUND
Although the application of vascularized free bone muscle flap to reconstruct the mandible has become a standardized approach for mandible reconstruction, the results of its reconstruction are not always satisfactory. The purpose of this study was to identify the types of mandibular and condylar defects by analyzing the unsatisfactory cases of mandibular reconstruction in clinical practice, and to provide some clinical experience of reconstruction.
METHODS
Our study retrospectively analyzed 364 patients who underwent mandibular resection and vascularized free bone flap reconstruction of the mandible and temporomandibular joint (TMJ). We innovatively proposed a "VSCU" classification system (V: vertical position, S: sagittal position, C: coronal position, U: condylar resection is not required) by analyzing computed tomography (CT) scans of mandibular branches and TMJs.
RESULTS
In all, 221 cases of free iliac muscle flap and 143 cases of fibula muscle flap were included in this study, of which 23 cases had unsatisfactory results after TMJ reconstruction. We classified 23 patients with unsatisfactory mandibular reconstruction according to the "VSCU" classification system. The most common type was U + V + SfC (n=8), followed by V - SfC + U + (n=4), V - s + C + U + (n=3), V - sbcou - (n=3), V - SBC + U + (n=2), V - s + C + U - (n=1). The most common classification was insufficient mandibular rami length, followed by condylar sagittal anteriorization. There was no significant change in the position of condyle on the healthy side during mandibular reconstruction involving condyle. P1 on the affected side was 52.28±4.17 mm before operation and 58.94±5.65 mm after operation, P<0.01; P2 was 12.83±3.49 mm before operation and 24.90±7.15 mm after operation. S2 was 4.54±2.84 mm before operation and 19.10±8.54 mm after operation. A2 was 11.46±3.35 mm before operation and 24.15±8.29 mm after operation. The P values were all less than 0.01, and the differences were statistically significant.
CONCLUSIONS
We propose to use the "VSCU" classification system for accurate 3-dimensional (3D) analysis and positioning, and then obtain accurate models through computer-aided design and manufacturing (CAD/CAM), which can reduce the occurrence of poor reconstruction effect and unreasonable joint position, and is worthy of clinical promotion.
PubMed: 38617172
DOI: 10.21037/qims-23-1444 -
Imaging Science in Dentistry Mar 2024This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography.
PURPOSE
This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography.
MATERIALS AND METHODS
In total, 210 joints from 183 patients (144 females, 39 males, ranging from 12 to 88 years old with a mean age of 44.75±19.97 years) diagnosed with temporomandibular joint osteoarthritis were stratified by age. Mandibular condyle position and bony changes (flattening, erosion, osteophytes, subchondral sclerosis, and subchondral pseudocysts in both the condyle and articular eminence, thickening of the glenoid fossa, joint space narrowing, and joint loose bodies) were evaluated through cone-beam computed tomography. After adjusting for sex, the association between age groups and radiographic findings was analyzed using both a multiple regression model and a multinomial logistic regression model (α=0.05).
RESULTS
The prevalence of joint space narrowing and protruded condyle position in the glenoid fossa significantly increased with age (<0.05). The risks of bony changes, including osteophytes and subchondral pseudocysts in the condyle; flattening, erosion, osteophyte, and subchondral sclerosis in the articular eminence; joint loose bodies; and thickening of the glenoid fossa, also significantly rose with increasing age (<0.05). The number of radiographic findings increased with age; in particular, the increase was more pronounced in the temporal bone than in the mandibular condyle (<0.05).
CONCLUSION
Increasing age was associated with a higher frequency and greater diversity of bony changes in the temporal bone, as well as a protruded condyle position in the glenoid fossa, resulting in noticeable joint space narrowing in temporomandibular joint osteoarthritis.
PubMed: 38571783
DOI: 10.5624/isd.20230229