Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.

Categorizing temporomandibular joint arthroscopic procedures for a better clinical practice and teaching.

OBJECTIVE: To provide some clarity to the confusion in the terminology used to classify arthroscopic procedures for the treatment of temporomandibular joint (TMJ) internal derangement (ID) and osteoarthrosis (OA). MATERIAL AND METHODS: The author introduces a new method for categorizing TMJ arthroscopic procedures more accurately, intending to establish a reference point from which further clinical series may built their analyses. RESULTS: Six categories are proposed for establishing a clear distinction among performed arthroscopic procedures: Level Ia, arthroscopic lavage (AL); Level Ib, arthroscopic lysis and lavage (ALL); Level Ic, ALL "needle-therapy"; Level IIa, simple operative arthroscopy (OA); Level IIb, advanced OA; and Level III, OA with discopexy. Several arthroscopic procedures, such as lysis of adherences, coblation of the retrodiscal tissue, anterior myotomy of the lateral pterigoid muscle, or discopexy, are classified in each category depending on the need (or not) to use of one or two working cannulas. CONCLUSION: Teaching and training of maxillofacial surgeons in the acquisition of the skills to perform arthroscopy should be based on a step-by-step approach following this proposed classification. Besides, future clinical series on arthroscopy of the TMJ for the treatment of ID and/or osteoarthrosis may benefit from a clear distinction of the performed arthroscopic procedure in terms of evaluating outcomes and complications.

Evaluation of Two Active System Encapsulant Matrices with Quercetin and Bacillus clausii for Functional Foods.

Currently, demand for functional foods is increasing in the public interest in order to improve life expectations and general health. Food matrices containing probiotic microorganisms and active compounds encapsulated into carrier agents are essential in this context. Encapsulation via the lyophilisation method is widely used because oxidation reactions that affect physicochemical and nutritional food properties are usually avoided. Encapsulated functional ingredients, such as quercetin and Bacillus clausii, using two carrier agents' matrices-I [inulin (IN), lactose (L) and maltodextrin (MX)] and II [arabic (A), guar (G), and xanthan (X) gums)]-are presented in this work. A D-optimal procedure involving 59 experiments was designed to evaluate each matrix's yield, viability, and antioxidant activity (AA). Matrix I (33.3 IN:33.3 L:33.3 MX) and matrix II (33.3 A:33.3 G:33.3 X) exhibited the best yield; viability of 9.7 log10 CFU/g and 9.73 log10 CFU/g was found in matrix I (using a ratio of 33.3 IN:33.3 L:33.3 MX) and matrix II (50 G:50 X), respectively. Results for the antioxidant capacity of matrix I (100 IN:0 L:0M X) and matrix II (0 A:50 G:50 X) were 58.75 and 55.54 (DPPH* scavenging activity (10 µg/mL)), respectively. Synergy between matrices I and II with use of 100IN:0L:OMX and 0A:50G:50X resulted in 55.4 log10 CFU/g viability values; the antioxidant capacity was 9. 52 (DPPH* scavenging activity (10 µg/mL). The present work proposes use of a carrier agent mixture to produce a functional ingredient with antioxidant and probiotic properties that exceed the minimum viability, 6.0 log10 CFU/g, recommended by the FAO/WHO (2002) to be probiotic, and that contributes to the recommended daily quercetin intake of 10-16 mg/day or inulin intake of 10-20 g/day and dietary fibre intake of 25-38 g per day.

Arthroscopic Disc Repositioning Techniques of the Temporomandibular Joint Part 2: Resorbable Pins.

Arthroscopic rigid fixation (ARF) of the temporomandibular joint (TMJ) with resorbable pins and other advanced arthroscopic disc repositioning (ADR) techniques by sutures has provided a renewed interest in the role played by the disc in the treatment of the most severe cases of TMJ ID with anterior disc displacement with severe limitation of mouth opening. These techniques may be the last step prior to open TMJ surgery, if other less complex operative arthroscopic techniques (OAT) have previously failed, or for those cases in which no predictable results are expected with simpler OAT due to the presence of a severe displaced disc or closed lock. In this article, ARF with resorbable pins is being approached, with a special focus on describing the technique while reporting its advantages and disadvantages. Also, potential complications and postoperative management and recovery, together with some advice in terms of pearls and pitfalls will be exposed.

Evaluation of a biocoagulant from devilfish invasive species for the removal of contaminants in ceramic industry wastewater.

This study evaluated the effectiveness of a biocoagulant produced from the devilfish invasive species and its combination with two chemical coagulants (aluminum sulfate and ferric sulfate) to remove turbidity, chemical oxygen demand, and total suspended solids in ceramic industry wastewater using a combined experimental design of Mixture-Process. This design optimized the coagulation process and evaluated the effects and interactions between mixture components and coagulant doses. An analysis of variance was used to analyze the experimental data obtained in the study, and the response surface plots by response type (turbidity, chemical oxygen demand, and total suspended solids) were obtained. Results showed that the coagulation treatment could be technically and economically feasible since efficiencies of turbidity, chemical oxygen demand, and total suspended solids removal of 74, 79, and 94% could be achieved using an optimal coagulant dose of 800 mg/L with a mixture of 35% biocoagulant and 65% ferric sulfate. Analysis of variance results showed that the models are significant, and the lack of fit is not required according to the probability value (p value), which were < 0.0001, and > 0.05, respectively. Hence, the experimental data were fitted to a combined reduced special cubic x linear model. These results support the use of devilfish meal as a biocoagulant, being more feasible in dual systems when mixed with ferric sulfate.

Lippia graveolens HBK oleoresins, extracted by supercritical fluids, showed bactericidal activity against multidrug resistance Enterococcus faecalis and Staphylococcus aureus strains.

OBJECTIVE: The aim of this work was to characterize Lippia graveolens oleoresins, obtained by Supercritical Fluid Extraction (SFE), from crops collected at different locations in Mexico. The antimicrobial effect of oleoresins was tested in reference strains and clinical isolates of susceptible and multidrug-resistant (MDR) strains of Enterococcus faecalis and Staphylococcus aureus. SIGNIFICANCE: The increasing of MDR strains is becoming a global public health problem that has led to the search for new treatments, and essential oils have resurged as a source of compounds with bactericidal functions. Oregano essential oil has attracted attention recently, however, this oil is mainly obtained by hydro-distillation (uses large amounts of water) or solvents extraction (potential contaminant). SFE has gained popularity as it represents an environmentally friendly technology. METHODS: L. graveolens oleoresins were obtained by SFE, total phenol contents were quantified by Folin-Ciocalteu method, the identification of compounds and thymol and carvacrol quantification was carried out by GC-MS. The antimicrobial activity was tested by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). RESULTS: SFE showed higher yields compared with the hydro-distillation process. L. graveolens grown in different Mexican locations showed differences in oleoresin composition and a slightly different antimicrobial capacity against clinical isolates. CONCLUSIONS: It was demonstrated that SFE is an efficient technology for extracting L. graveolens oleoresins. Additionally, the solvent-free extraction method and the observed antimicrobial effect increase the applications of these oleoresins in fields, such as cosmetics, food industry, medicine, amongst others.

A randomized controlled preclinical trial on 3 interposal temporomandibular joint disc implants: TEMPOJIMS-Phase 2.

The effort to develop an effective and safe temporomandibular joint (TMJ) disc substitute has been one of the mainstreams of tissue engineering. Biodegradable customized scaffolds could approach safety and effectiveness to regenerate a new autologous disc, rather than using non-biodegradable materials. However, it is still technically challenging to mimic the biomechanical properties of the native disc with biodegradable polymers. In this study, new 3D tailored TMJ disc implants were developed: (1) Poly(glycerol sebacate) (PGS) scaffold reinforced with electrospun Poly(εcaprolactone) (PCL) fibers on the outer surface (PGS+PCL); (2) PCL and polyethylene glycol diacrylate (PEGDA) (PCL+PEGDA); and (3) PCL. The TMJ implants were tested in a randomized preclinical trial, conducted in 24 black Merino sheep TMJ, perfoming bilateral interventions. Histologic, imaging, and kinematics analysis was performed. No statistical changes were observed between the PGS+PCL disc and the control group. The PCL+PEGDA and PCL groups were associated with statistical changes in histology (p = 0.004 for articular cartilage mid-layer; p = 0.019 for structure changes and p = 0.017 for cell shape changes), imaging (p = 0.027 for global appreciation) and dangerous material fragmentation was observed. No biomaterial particles were observed in the multi-organ analysis in the different groups. The sheep confirmed to be a relevant animal model for TMJ disc surgery and regenerative approaches. The PCL and PCL+PEGDA discs presented a higher risk to increase degenerative changes, due to material fragmentation. None of the tested discs regenerate a new autologous disc, however, PGS+PCL was safe, demonstrated rapid resorption, and was capable to prevent condyle degenerative changes.

Formaldehyde and tripolyphosphate crosslinked chitosan hydrogels: Synthesis, characterization and modeling.

In this work, the synthesis of crosslinked chitosan hydrogels was performed by ionic and covalent interactions using tripolyphosphate (TPP) and formaldehyde (CH2O), respectively. The hydrogels synthesis was performed using a D-Optimal combined experiment design with two mixing variables, A and B representing the TPP weight fraction (slack variable) and CH2O weight fraction, respectively, and three (3) process variables C-chitosan concentration, D-cross-linker concentration, and E-Contact time. The response variables studied were the point of zero charge (pHPZC), the swelling ratio (SW), and the equilibrium water content (EWC), which are relevant physicochemical properties in applications such as the pollutant removal from water. According to the ANOVA results, the model obtained was significant; this means it can be adequately used to predicting pHPZC, SW, and EWC from the mixing and process variables, obtaining coefficients of determination R2 of 0.9572, 0.8900, and 0.8447, respectively. The pHPZC is affected by chitosan concentration, while the crosslinker concentration influences the SW, and the contact time most significantly affected the EWC. Morphology and hardness tests, thermal stability, infrared spectroscopy, and scanning electron microscopy, allowed verifying the types of crosslinking of chitosan with TPP and CH2O.

Experimental data and predictive equation of the specific heat capacity of fruit juice model systems measured with differential scanning calorimetry.

Specific heat capacity ( C P ) is regarded as a fundamental parameter for the design, operation, and optimization of the heat transfer equipment widely used in the food industry. Using the calorimetric ASTM E1269-11 standard procedure, the C P -temperature ( C P ( T ) ) curves of fruit juice model systems prepared at different mass fractions of fructose/glucose/sucrose/citric acid/pectin and water were measured. Thus, experimental data of C P for solid samples in crystalline and amorphous states from -80 °C up to the melting temperature range and for aqueous samples from -80 to 110 °C were generated. In the tested temperature interval, the C P of crystalline, amorphous, and aqueous samples were found to be in the ranges of 0.037 ± 0.020 to 5.61 ± 0.04; 0.061 ± 0.004 to 3.12 ± 0.19, and 0.363 ± 0.05 to 3.24 ± 0.14 kJ/kg °C, respectively. Also, a generalized empirical equation based on the type and concentration of components was developed to predict the C P ( T ) curves of the studied samples. The proposed equation exhibited a low error sum of squares (SSE <  57.3) and a high coefficient of determination (R2 > 0.927). An analysis of variance (ANOVA) was performed with a confidence level of 95% (p < 0.05). The C P ( T ) curves were influenced by temperature, thermal transitions, water, solid types, and compound interactions. Glucose was one of the solids that most significantly influenced the C P values of samples. PRACTICAL APPLICATION: The experimental specific heat capacity data and empirical equation proposed in this study are relevant to the design, evaluation, and optimization of heat transfer equipment involved in many foods and biochemical industrial processes such as cryopreservation, frozen storage, freezing, chilling, drying, and the cooking of hard candies.

Reporte de familias con distrofia miotónica de Steinert pesquisadas en la Atención Primaria de Salud / Report of families with Steinert´s Myotonic Dystrophy surveyed in Primary Health Care

RESUMEN Introducción: la distrofia miotónica de Steinert. Es una enfermedad heredo familiar con patrón de transmisión autosómico dominante. Objetivo: describir familias con distrofia miotónica de Steinert pesquisadas en la Atención Primaria de Salud. Presentación de familias: se trata de una muestra de 126 miembros pertenecientes a dos familias, residentes en la provincia Pinar del Río, Cuba, en la que varios de sus miembros tenían diagnosticada la enfermedad. Se realizó un pesquisaje durante el año 2019, y entre enero y marzo del 2020, a cada miembro de ambas familias, se les completó las genealogías y evaluaron las características clínicas. Se trabajó con algunas variables relacionadas con las formas clínicas de la enfermedad según las generaciones. Resultados: se presentaron mediante el árbol genealógico dos familias, con 40 y 86 miembros, de los municipios de Minas de Matahambre y Pinar del Río respectivamente. En el primer municipio se registraron nueve personas con la forma leve y clásica de la enfermedad, de estas más de la mitad no conocían su condición, 21 personas eran aparentemente sintomáticas. En el segundo municipio, 21 casos fueron evaluados con alguna forma clínica de la enfermedad, que con respecto al total de casos pesquisados representaron el 26,5 %. Conclusiones: es esencial la pesquisa a las familias con distrofia miotónica de Steinert, ya que existe una disociación de los signos clínicos y expresión variable de la enfermedad. Es la Atención Primaria de Salud el escenario que permite el diagnóstico precoz y manejo multidisciplinario.

ABSTRACT Introduction: the dystrophy miotónica of Steinert. It is an illness I inherit family with pattern of transmission dominant autosómico. Objective: to describe families with Steinert´s Myotonic Dystrophy, surveyed in Primary Health Care. Report of families: it is about a sample of 126 members belonging to two families, in which several of their members had been diagnosed with the entity; both families are from Pinar del Río province, Cuba. A survey was conducted during 2019, and between January and March 2020, each member of both families had their genealogies completed and their clinical characteristics evaluated; working with some variables related to the clinical types of this entity according to the generations. Results: two families were presented through the genealogical tree, with 40 and 86 members from the municipalities of Minas de Matahambre and Pinar del Río municipalities respectively. In the first municipality, nine persons (9) were registered with the mild and classic type of the disease, of these more than 50 % did not know their condition, and 21 persons were apparently symptomatic. In the second municipality, 21 cases were evaluated some clinical characteristics of the disease, which with respect to the total number of cases surveyed represented 26,5 %. Conclusions: it is essential to study families with Steinert's Myotonic Dystrophy, since there is a dissociation of clinical signs and variable expression of the disease. It is the Primary Health Care the setting which allows early diagnosis and multidisciplinary management of this disease.

The Influence of Maltodextrin on the Thermal Transitions and State Diagrams of Fruit Juice Model Systems.

The state diagram, which is defined as a stability map of different states and phases of a food as a function of the solid content and temperature, is regarded as fundamental approach in the design and optimization of processes or storage procedures of food in the low-, intermediate-, and high-moisture domains. Therefore, in this study, the effects of maltodextrin addition on the freezing points (Tm', Tm) and glass transition temperatures (Tg', Tg) required for the construction of state diagrams of fruit juice model systems by using differential scanning calorimetry methods was investigated. A D-optimal experimental design was used to prepare a total of 25 anhydrous model food systems at various dry mass fractions of fructose, glucose, sucrose, pectin, citric acid, and maltodextrin, in which this last component varied between 0 and 0.8. It was found that maltodextrin mass fractions higher than 0.4 are required to induce significant increases of Tg', Tm', Tg, and Tm curves. From this perspective, maltodextrin is a good alternative as a cryoprotectant and as a carrier agent in the food industry. Furthermore, solute-composition-based mathematical models were developed to evaluate the influence of the chemical composition on the thermal transitions and to predict the state diagrams of fruit juices at different maltodextrin mass fractions.

Potential of Mean Force Calculations for an SN2 Fluorination Reaction in Five Different Imidazolium Ionic Liquid Solvents Using Quantum Mechanics/Molecular Mechanics Molecular Dynamics Simulations.

The use of ionic liquids (ILs) as both catalysts and solvents in a wide range of chemical reactions has received considerable attention over the last few years due to their positive effects in enhancing reaction rates and selectivities. In this work, hybrid quantum mechanics/molecular mechanics (QM/MM) molecular dynamics simulations were carried out in conjunction with umbrella-sampling techniques to study the bimolecular nucleophilic substitution (SN2) fluorination reaction between propyl-mesylate and potassium fluoride using five ILs as solvents, specifically, 1-butyl-3-methylimidazolium mesylate ([C4mim][OMs]), 1-butyl-3-methylimidazolium tetrafluoroborate ([C4mim][BF4]), 1-butyl-3-methylimidazolium trifluoroacetate ([C4mim][CF3COO]), 1-butyl-3-methylimidazolium bromide ([C4mim][Br]), and 1-butyl-3-methylimidazolium chloride ([C4mim][Cl]) at 373.15 K. The QM region (reactive part) in all QM/MM systems was simulated using the Parametric Method 6 (PM6) semiempirical methods, and for the MM region (IL solvent), classical force fields (FF) were employed, with the FF developed within the group. The calculated activation free energy barriers (ΔG‡) for the SN2 reaction in the presence of [C4mim][OMs] and [C4mim][BF4] ILs were in agreement with the experimental values reported in the literature. On the other hand, only predicted values were obtained for the activation energies for the [C4mim][CF3COO], [C4mim][Br], and [C4mim][Cl] ILs. These activation energies indicated that the SN2 reaction would be more facile to proceed using the [C4mim][Cl] and [C4mim][OMs] ILs, in contrast with the use of [C4mim][Br] IL, which presented the highest activation energy. Energy-pair distributions, radial distribution functions, and noncovalent interactions (NCI) were also calculated to elucidate the molecular interactions between the reactive QM region and the solvents or reaction media. From these calculations, it was found that not only the reactivity can be enhanced by selecting a specific anion to increase the K-F separation but also the cation plays a relevant role, producing a synergetic effect by forming hydrogen bonds with the fluorine atom from KF and with the oxygen atoms within the mesylate leaving group. Three interactions are significant for the IL catalytic behavior, FQM-HX, KQM-anion, and OQM-HX interactions, where the FQM and KQM labels correspond to fluorine and potassium atoms from the KF salt, OQM corresponds to oxygen atoms within the mesylate leaving group (reactant), and HX refers to hydrogen atoms within the IL cation. The NCI analysis revealed that KQM-anion interactions are of weak type, indicating the importance of hydrogen bond interactions from the cation such as FQM-HX and OQM-HX for the catalytic behavior of ILs.

Synthesis and characterization of hydrochar from industrial Capsicum annuum seeds and its application for the adsorptive removal of methylene blue from water.

Chili seeds (CS) represent one of the most abundant residues in Mexico due to the high production and consumption. In this work, CS were used as raw material for the production of low-cost adsorbents for the removal of methylene blue from water. The adsorbents were synthesized from a hydrothermal treatment (based on a surface response experiment design) and characterized texturally by assessing changes in their properties. The mass yield (%R), carbon content (%C), and the second order adsorption rate constant (k2) were derived in relation to a list of input variables (e.g., the reaction temperature, residence time, and water/biomass ratio). Accordingly, those output variables were affected most sensitively by temperature and/or residence time, while changes of the water/biomass ratio were insignificant. Besides, an increase in the reaction temperature favored the degradation of the lignocellulosic material with increases in the carbon fixation. The adsorption capacity of methylene blue (MB) by the hydrochars depended drastically on the oxygen/carbon ratio. As such, the maximum adsorption capacity value of 145 mg g-1 was attained at the initial MB concentration of ~3000 µM (optimal oxygen/carbon value of 0.43). On the other hand, the maximum partition coefficient (KD) was estimated as 2.96 µM-1 mg g-1 with the initial/equilibrium concentrations of 20.5/6.93 µM. The performance evaluation between different studies, when made in terms of KD, suggests that the tested hydrochar should be one of the best adsorbents to treat methylene blue, especially at near-real environmental conditions (e.g., below micromolar levels).

Long-Term Dislocation of the Mandible: Is there an Algorithm to Success? Intraoperative Decision and Review of Literature.

PURPOSE: Long-term TMJ dislocation is a rare condition. It occurs when an acute luxation remains untreated in time. METHODS: A 52-year-old man presented with a long-term TMJ luxation in the context of Steinert's disease. A discectomy together with condylectomy and eminectomy was performed, obtaining an adequate reduction of the luxated condyle and disc. RESULTS: Twelve months after the operation, the condition has not recurred at all. A stable and centred occlusion was checked; his MIO was over 30 mm. CONCLUSION: The combination of these three techniques could be a good option in cases of Steinert's myotonia, where the condyle luxation becomes chronic and irreducible due to the altered neuromuscular condition. There is still no consensus regarding the treatment for long-term TMJ dislocations. New and more solid studies may be needed in order to find adequate treatment protocols for this condition.

Is the "Habsburg jaw" related to inbreeding?

Background: The "Habsburg jaw" has long been associated with inbreeding due to the high prevalence of consanguineous marriages in the Habsburg dynasty. However, it is thought that mandibular prognathism (MP) is under the influence of a dominant major gene.Aim: To investigate the relationship between the "Habsburg jaw" and the pedigree-based inbreeding coefficient (F) as a relative measure of genome homozygosity.Subjects and methods: The degree of MP and maxillary deficiency (MD) of 15 members of the Habsburg dynasty was quantified through the clinical analysis of 18 dysmorphic features diagnosed from 66 portraits.Results: A statistically significant correlation (r = 0.711, p = 0.003) between MP and MD was observed among individuals. Only MP showed a statistically significant positive regression on F as evidenced from univariate analysis (b = 6.36 ± 3.34, p = 0.040) and multivariate analysis (PCA) performed from single dysmorphic features (b = 14.10 ± 6.62, p = 0.027, for the first PC).Conclusion: Both MP and MD are generally involved in the "Habsburg jaw." The results showed a greater sensitivity to inbreeding for the lower third of the face and suggest a positive association between the "Habsburg jaw" and homozygosity and therefore a basically recessive inheritance pattern.

Evaluation of the Spray Drying Conditions of Blueberry Juice-Maltodextrin on the Yield, Content, and Retention of Quercetin 3-d-Galactoside.

The influence of the processing conditions during the spray drying of mixtures of blueberry juice (BJ) and maltodextrin (MX) was determined quantitatively by the analysis of variance (ANOVA), and qualitatively by the surface response plots (SRP). The effect of two independent variables (inlet temperature, and MX concentration), and one categorical variable (type of MX), was determined on the yield (Y), content (Q), and retention (R) of the antioxidant quercetin 3-d-galactoside. From the ANOVA results, the concentration was the main variable affecting Y and Q, while temperature had a negligible effect, and the low molecular weight MXs exhibited a better response. The physicochemical characterization showed that the powder appearance and microstructure remained unaffected, but size and morphology of the particles varied with the processing conditions. This study established the optimal processing conditions for the spray drying of BJ-MX, and the application limits of the MXs based on the molecular weight distribution.

Arthroscopy of the Inferior Compartment of the Temporomandibular Joint: A New Perspective.

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.

Preclinical randomized controlled trial of bilateral discectomy versus bilateral discopexy in Black Merino sheep temporomandibular joint: TEMPOJIMS - Phase 1- histologic, imaging and body weight results.

INTRODUCTION: The role of temporomandibular joint (TMJ) surgery is not well defined due to a lack of quality randomized controlled clinical trials, comparing different TMJ surgical treatments with medical and placebo interventions. The temporomandibular joint interposal study (TEMPOJIMS) is a rigorous preclinical trial divided in 2 phases. In phase 1 the authors investigated the role of the TMJ disc and in phase 2 the authors evaluated 3 different interposal materials. The present work of TEMPOJIMS - phase 1, aims to evaluate histopathologic and imaging changes of bilateral discectomy and discopexy in Black Merino sheep TMJ, using a high-quality trial following the ARRIVE guidelines. MATERIAL AND METHODS: This randomized, blinded and controlled preclinical trial was conducted in 9 Black Merino sheep to investigate histopathologic (primary outcome), imaging and body weight (secondary outcomes) changes after bilateral discectomy, discopexy and sham surgery. RESULTS: Significant changes were noticed in discectomy group, both in imaging and histopathologic analyses. Body weight changes were most pronounced in the discectomy group in the first 4 months after surgery with recovery to baseline weight 6 months after surgery. Discopexy induced nonsignificant changes in histopathologic, imaging and body weight analyses. CONCLUSIONS: This study reinforces the importance of developing an effective interposal material to substitute the TMJ disc and the need to explore the molecular mechanisms that underlie TMJ cartilage degeneration. The study design proposed in TEMPOJIMS represents an important progress towards future rigorous TMJ investigations.