Does Temporomandibular Joint Magnetic Resonance Imaging Diagnosis Support Clinical Examination Diagnosis Following Diagnostic Criteria for Temporomandibular Disorders?

PURPOSE: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) has been validated as a clinical diagnostic guideline with high-sensitivity and -specificity in identifying TMDs. The purpose of this study was to evaluate the agreement between DC/TMD diagnoses and magnetic resonance imaging (MRI) diagnoses in patients with TMD. METHODS: A prospective cohort study was conducted on patients with TMD. The predictor variable was the clinical diagnosis of TMD based on DC/TMD criteria. The outcome variable was the MRI diagnosis of TMD. The diagnoses used for both the predictor variable and the outcome variable were the same. They were normal, disc displacement with reduction (DDWR), DDWR with intermittent locking, disc displacement without reduction (DDWOR) with limited opening, DDWOR without limited opening, degenerative joint disease, and subluxation. Age and gender of the patients and number of joints evaluated were covariates. Each subject had clinical examination performed by two independent Oral and Maxillofacial Surgeons. All subjects had a bilateral temporomandibular joint (TMJ) MRI performed which was evaluated by a radiologist. The correlation between the clinical and MRI diagnoses was calculated using Cohen's kappa value with a P value of <.05 considered significant. RESULTS: A total of fifty patients (100 TMJs) were enrolled with 38 females and 12 males. The mean ages were 31.92 and 31.75 years, respectively, with a total of 100 TMJs analyzed. Internal derangement was clinically identified in 76% of the joints and with MRI in 69% of joints. The Cohen's kappa value between DC/TMD and MRI diagnoses was found to be κ = 0.720 (P < .01). The respective sensitivity and specificity in determining disc position clinically for DDWR was 1 and 0.96; for DDWR with intermittent locking 0.78 and 0.91; for DDWOR with limited opening 0.9 and 0.98; for DDWOR without limited opening 1 and 0.9; for degenerative joint disease 0.63 and 0.97 and for subluxation 0.28 and 1.00. CONCLUSION: The DC/TMD clinical examination performed well in all types of disc displacement but is less reliable than MRI in detecting the presence of degenerative disc diseases and subluxation.

Evaluation of the effects of arthrocentesis combined with occlusal stabilization splint on disc displacement without reduction-induced acute and closed lock. A prospective cohort study.

OBJECTIVE: Disc displacement without reduction (DDWoR) of the temporomandibular joint is associated with limited mouth opening and arthralgia. In the natural course of the disorder, there is a tendency to progress to degenerative joint diseases. First-line treatment aims to reduce pain and restore joint function. The current study aims to examine the efficacy of an occlusal stabilization splint applied simultaneously with arthrocentesis as first-line treatment in acute and chronic closed-locks. MATERIALS AND METHODS: The present prospective clinical trial included 40 patients who were diagnosed with DDWoR induced chronic (Group 1, n = 23) and acute (Group 2, n = 17) closed-locks. All participants underwent single session arthrocentesis and were applied occlusal stabilization splints. Maximum mouth opening amounts (MMO), Visual analogue scale (VAS), and McGill pain questionnaire (MPQ) scores were evaluated at baseline, on the operation day, and on seven days after the intervention. The obtained data was analyzed with the Wilcoxon signed-rank, Mann-Whitney U, Fisher's exact, Spearman's correlation tests. RESULTS: According to the baseline data, a significant increase was observed in the amount of MMO in postoperative measurements (p = 0.001 and p < 0.001). A statistically significant decrease in MPQ scores was observed in the postoperative period (p < 0.001 and p < 0.001). While a significant difference was observed between the postoperative VAS scores, the scores of Group 2 were lower (p = 0.018). CONCLUSION: Although combined arthrocentesis and occlusal stabilization splint provided significant changes for acute and chronic closed-locks in line with first-line treatment goals, acute closed-lock with arthralgia responded better. CLINICAL TRIAL REGISTRATION NUMBER: NCT05671549.

Role of VEGF I/D variant in suspectibility to odontogenic cyst formation.

Odontogenic cysts, are located in the jawbones, filled with fluid surrounded by epithelial lining and fibrous connective tissue. Vascular endothelial growth factor (VEGF) can induce physiological and pathological angiogenesis and is an endothelial cell-specific mitogen. The aim of the present study was to investigate whether any possible association between the VEGF insertion/deletion (I/D) variant and odontogenic cyst in Turkish population. Clinical information and venous blood samples were collected from 62 odontogenic cyst patients and 98 healthy controls. DNA was isolated from peripheral blood leukocytes. Genotyping of the VEGF I/D variant was done by the polymerase chain reaction (PCR) method. There was a statistically differece in terms of VEGF I/D allele frequencies between patients and controls. VEGF I/D variant I allele frequency was more prevalant in patients compared to controls (p = 0.006411, OR: 2.08, 95%Cl: 1.322-3.272). A statistically significant association was observed when the patients were compared with the controls according to D/D + I/D versus I/I genotype (p = 0.0508, OR: 1.925, 95%Cl: 0.872-4.246). The genotype distribution of VEGF I/D was not statistically different between patients and controls (p > 0.05). For the first time, our results provided evidence supporting the odontogenic cyst formation associated with the I/D variant at the promoter region of the VEGF gene in a group of Turkish population. Although it was seen in our study that the I/D variant in the promoter region of the VEGF gene supports odontogenic cyst formation, large-scale studies are needed to elucidate the effect of this variant on odontogenic cysts.

Evaluation of prevalence of temporomandibular disorders based on DC / TMD Axis I diagnosis in Turkish population and correlation with Axis II.

PURPOSE: The prevalence of DC / TMD diagnosis of individuals with internal derangement of TMJ who want to receive TMD treatment in a tertiary clinic in the Turkish population and comparison of the criteria applied in Axis I and Axis II. METHODS: This study was carried out on 200 individuals older than 18 years of age who have internal disorder of Temporomandibular Joint (TMJ). Diagnostic Criteria for Temporomandibular Disorders (DC / TMD) Axis I and II were applied. RESULTS: The female to male ratio of individuals with internal derangement of TMJ in the Turkish population was 3.5. The Pearson correlation coefficient between the internal derangement of the Right TMJ and the internal derangement of the Left TMJ is 0.804 and has a statistically significant relationship (p <0.05). CONCLUSIONS: For DC / TMD, a more comprehensive study is needed to compare the results found in the Turkish population with other populations.

Evaluation of postoperative changes in the course of mandibular canals impacted by cystic lesions.

BACKGROUND: This study aims to determine the positional alterations in the course of mandibular canal, which were caused by the common cystic lesions in the posterior mandible. Also, the effects of treatment methods on bone formation were evaluated. METHODS: We designed a retrospective cohort study with patients which were treated due to cystic lesions in the maxillofacial region between the years 2012-2018. Forty eight subjects were included and grouped regarding histopathologic diagnoses (radicular dentigerous and odontogenic keratocyst) and treatment methods (enucleation and marsupialization). The mean (range) of patients' age was 31.25 (18-66) years, and there were 32 male and 16 female individuals. The displacement of mandibular canals was verified on preoperative cone-beam computed tomographic images. The measurements of displacement and bone formation were performed on panoramic radiographs. In the statistical analysis of the data, descriptive statistics, parametric independent sample t-test, non-parametric Kruskal Wallis test, and one-way analysis of variance test were utilized. RESULTS: All the evaluated mandibular canals were replaced by a mean(SD) of 5.46(2.59) mm after the lesions eliminated, which was significant in the marsupialization group (p = 0.002). The bone formation was significantly higher in the enucleation group (p = 0.003). The multiple regression analyses revealed that the treatment methods significantly influenced the replacement of mandibular canal (p < 0.001) and the bone formation (p = 0.026). CONCLUSION: In cases where there is an adequate distance between the lesion and the mandibular canal, the enucleation technique was found to be superior in terms of bone formation and the amount of bone height obtained.

A Bibliometric Analysis of International Publication Trends in Total Temporomandibular Joint Replacement Research (1986-2020).

PURPOSE: To conduct a bibliometric analysis that systematically characterizes publications on temporomandibular joint temporomandibular joint replacement from 1986 to 2020. MATERIALS AND METHODS: The articles were retrieved on the same day from the Web of Science Core Collection database of the Web of Science on December 31, 2020 to prevent bias due to daily database updates. Excel 2016, CiteSpace IV, and VOSviewer v1.6.16 were used for analysis. RESULTS: A sum of 610 publications from 1986 to 2020 were analyzed. The highest number of publications were identified and published in the Journal of Oral and Maxillofacial Surgery. The United States had the highest number of publications and the highest H-index. The highest co-citations were from Mercuri. CONCLUSIONS: In this study, developments, the most influential publications, journals, and countries in the field of temporomandibular joint temporomandibular joint replacement were determined based on evidence through bibliometric analysis.

Differential immunohistochemical expression of type I collagen and matrix metalloproteinase 2 among major salivary glands of young and geriatric mice

Abstract Objective This study aimed to demonstrate the immunohistochemical changes associated with MMP-2 and type 1 collagen separately for the first time in the major salivary glands (the parotid, submaxillary, and sublingual glands) that occur with aging in mice. Material and Methods Fourteen Balb/c white mice (50-80 g) were used in this study. The animals were divided into two equal groups. Group I consisted of young animals (2-month-old) (n=7) and Group II consisted of older animals (18-month-old) (n=7). After routine histological follow-ups, Hematoxylin-eosin (H&E), Masson's Trichrome staining and immunohistochemical staining was performed for type I collagen and MMP-2. Results We observed that there were age-related decreases in the number of acinar cells, increase in eosinophilic zymogen granules in cells, collagen accumulation in fibrotic areas and dilatation in interlobular ducts. Also, while type I collagen and MMP-2 immunoreactivity were moderate in the salivary glands of the young mice, they were high in the salivary glands of the old mice (p=0.001). In the H-score assessment, MMP-2 immunoreactivity was lower at a significant level in young mice than in old mice (p=0.001). Conclusions This study showed that anatomical, physiological and morphological abnormalities occur in all three major salivary glands as a natural consequence of aging.

Investigation of CD40 gene rs4810485 and rs1883832 mutations in patients with recurrent aphthous stomatitis.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is a common painful disorder affecting oral health, mucosa and overall quality of life. The etiopathogenesis of RAS remains unclear. RAS shows a large genetic diversity among the patients. In present study, we investigated whether CD40 gene rs4810485 and rs1883832 are associated with RAS and its clinical findings in Turkish patients. MATERIALS AND METHODS: Genomic DNA obtained from 387 individuals (160 patients with RAS and 227 healthy controls) were used in the study. CD40 gene rs4810485 and rs1883832 mutations were determined by using polymerase chain reaction with the specific primers. RESULTS: There was no statistically significant difference between the groups with respect to genotype and allele distribution (p>0.05, OR 0.94, 95% CI 0.70-1.28, OR 1.01 95% CI 0.75-1.37, respectively). Additionally, there was no statistically significant difference in the combined genotype analysis of CD40 gene rs4810485 and rs1883832 mutations (p>0.05). CONCLUSIONS: According to our results, we found that CD40 gene mutations are not associated with RAS. We are convinced that CD40 gene mutations do not predispose to develop RAS in Turkish population. To our knowledge, this is the first study regarding CD40 gene rs4810485 and rs1883832 mutations investigated in RAS patients.