Determination of intra-oral surface areas by cone-beam computed tomography analysis and their relation with anthrometric measurements of the head.

PURPOSE: Determination of intra-oral surface areas might contribute to our understanding of the physiology of the oral cavity and oral diseases. In previous studies, the intra-oral surface area was determined using a laborious and technically challenging method. Our aim was to develop an easy and non-invasive method to determine the intra-oral surface areas. METHODS: In this study, we used cone-beam computed tomography (CBCT) and digital analysis in 20 human cadavers to determine various intra-oral surface areas, based on digital segmentation. Next, we explored whether there was a relationship between various intra-oral surface areas and anthropometric measurements of the head using Pearson correlation coefficient. RESULTS: Using CBCT and digital analysis, it was possible to determine various intra-oral surface areas. On average, the total intra-oral surface area was 173 ± 19 cm2. Moderate, statistical significant correlations were observed between (1) the length of the head and the palatal surface area, as well as (2) the depth of the head and the surface area of the tongue. These correlations suggest the feasibility of estimating intra-oral surface areas without relying on CBCT imaging. CONCLUSIONS: This study presents a technique for measuring the intra-oral surface areas by CBCT imaging in combination with digital analysis. The results of this study suggest that anthropometric measurements of the head might be used to estimate the surface areas of the palate and tongue.

Aging does not change the compressive stiffness of mandibular condylar cartilage in horses.

OBJECTIVE: Aging can cause an increase in the stiffness of hyaline cartilage as a consequence of increased protein crosslinks. By induction of crosslinking, a reduction in the diffusion of solutions into the hyaline cartilage has been observed. However, there is a lack of knowledge about the effects of aging on the biophysical and biochemical properties of the temporomandibular joint (TMJ) cartilage. Hence, the aim of this study was to examine the biophysical properties (thickness, stiffness, and diffusion) of the TMJ condylar cartilage of horses of different ages and their correlation with biochemical parameters. MATERIALS AND METHODS: We measured the compressive stiffness of the condyles, after which the diffusion of two contrast agents into cartilage was measured using Contrast Enhanced Computed Tomography technique. Furthermore, the content of water, collagen, GAG, and pentosidine was analyzed. RESULTS: Contrary to our expectations, the stiffness of the cartilage did not change with age (modulus remained around 0.7 MPa). The diffusion of the negatively charged contrast agent (Hexabrix) also did not alter. However, the diffusion of the uncharged contrast agent (Visipaque) decreased with aging. The flux was negatively correlated with the amount of collagen and crosslink level which increased with aging. Pentosidine, collagen, and GAG were positively correlated with age whereas thickness and water content showed negative correlations. CONCLUSION: Our data demonstrated that aging was not necessarily reflected in the biophysical properties of TMJ condylar cartilage. The combination of the changes happening due to aging resulted in different diffusive properties, depending on the nature of the solution.

The contribution of collagen fibers to the mechanical compressive properties of the temporomandibular joint disc.

OBJECTIVE: The Temporomandibular Joint (TMJ) disc is a fibrocartilaginous structure located between the mandibular condyle and the temporal bone, facilitating smooth movements of the jaw. The load-bearing properties of its anisotropic collagenous network have been well characterized under tensile loading conditions. However, recently it has also been speculated that the collagen fibers may contribute dominantly in reinforcing the disc under compression. Therefore, in this study, the structural-functional role of collagen fibers in mechanical compressive properties of TMJ disc was investigated. DESIGN: Intact porcine TMJ discs were enzymatically digested with collagenase to disrupt the collagenous network of the cartilage. The digested and non-digested articular discs were analyzed mechanically, biochemically and histologically in five various regions. These tests included: (1) cyclic compression tests, (2) biochemical quantification of collagen and glycosaminoglycan (GAG) content and (3) visualization of collagen fibers' alignment by polarized light microscopy (PLM). RESULTS: The instantaneous compressive moduli of the articular discs were reduced by as much as 50-90% depending on the region after the collagenase treatment. The energy dissipation properties of the digested discs showed a similar tendency. Biochemical analysis of the digested samples demonstrated an average of 14% and 35% loss in collagen and GAG, respectively. Despite the low reduction of collagen content the PLM images showed considerable perturbation of the collagenous network of the TMJ disc. CONCLUSIONS: The results indicated that even mild disruption of collagen fibers can lead to substantial mechanical softening of TMJ disc undermining its reinforcement and mechanical stability under compression.

Biomechanical analysis of the influence of friction in jaw joint disorders.

OBJECTIVE: Increased friction due to impaired lubrication in the jaw joint has been considered as one of the possible causes for internal joint disorders. A very common internal disorder in the jaw joint is an anteriorly dislocated articular disc. This is generally considered to contribute to the onset of arthritic injuries. Increase of friction as caused by impairment of lubrication is suspected to be a possible cause for such a disorder. METHOD: The influence of friction was addressed by analysis of its effects on tensions and deformations of the cartilaginous structures in the jaw joint using computational biomechanical analysis. Jaw open-close movements were simulated while in one or two compartments of the right joint friction was applied in the articular contact. The left joint was treated as the healthy control. RESULTS: The simulations predicted that friction primarily causes increased shear stress in the articular cartilage layers, but hardly in the articular disc. CONCLUSIONS: This suggests that impaired lubrication may facilitate deterioration of the cartilage-subchondral bone unit of the articular surfaces. The results further suggest that increased friction is not a plausible cause for turning a normally functioning articular disc into an anteriorly dislocated one.

Biomechanical and biochemical characteristics of the mandibular condylar cartilage.

The human masticatory system consists of a mandible which is able to move with respect to the skull at its bilateral temporomandibular joint (TMJ) through contractions of the masticatory muscles. Like other synovial joints, the TMJ is loaded mechanically during function. The articular surface of the mandibular condyle is covered with cartilage that is composed mainly of collagen fibers and proteoglycans. This construction results in a viscoelastic response to loading and enables the cartilage to play an important role as a stress absorber during function. To understand its mechanical functions properly, and to assess its limitations, detailed information about the viscoelastic behavior of the mandibular condylar cartilage is required. The purpose of this paper is to review the fundamental concepts of the biomechanical behavior of the mandibular condylar cartilage. This review consists of four parts. Part 1 is a brief introduction of the structure and function of the mandibular condylar cartilage. In Part 2, the biochemical composition of the mandibular condylar cartilage is summarized. Part 3 explores the biomechanical properties of the mandibular condylar cartilage. Finally, Part 4 relates this behavior to the breakdown mechanism of the mandibular condylar cartilage which is associated with the progression of osteoarthritis in the TMJ.

Tensile stress patterns predicted in the articular disc of the human temporomandibular joint.

The direction of the first principal stress in the articular disc of the temporomandibular joint was predicted with a biomechanical model of the human masticatory system. The results were compared with the orientation of its collagen fibers. Furthermore, the effect of an active pull of the superior lateral pterygoid muscle, which is directly attached to the articular disc, was studied. It was hypothesized that the markedly antero-posterior direction of the collagen fibers would be reflected in the direction of the tensile stresses in the disc and that active pull of the superior lateral pterygoid muscle would augment these tensions. It was found that the tensile patterns were extremely dependent on the stage of movement and on the mandibular position. They differed between the superior and inferior layers of the disc. The hypothesis could only be confirmed for the anterior and middle portions of the disc. The predicted tensile principal stresses in the posterior part of the disc alternated between antero-posterior and medio-lateral directions.

Effects of ultrasound on the proliferation and differentiation of cementoblast lineage cells.

BACKGROUND: The purpose of this study was to investigate the effects of low-intensity pulsed ultrasound (LIPUS) stimulation on the proliferation and differentiation of cementoblast lineage cells. METHODS: An immortalized human periodontal ligament cell line (HPL) showing immature cementoblastic differentiation was used. Cultured HPL cells were subjected to LIPUS exposure (frequency = 1 MHz; pulsed 1:4; intensity = 30 mW/cm(2)) or sham exposure for 15 minutes per day. Expression levels of alkaline phosphatase (ALP), type I collagen (Col-I), runt-related gene 2 (Runx2), bone sialoprotein (BSP), osteocalcin (OCN), and osteopontin (OPN) mRNA were analyzed with real-time polymerase chain reaction analysis. Furthermore, ALP activity, collagen synthesis, and protein level of Runx2 were examined after 6 days of LIPUS exposure. RESULTS: mRNA and protein levels of ALP, Col-I, and Runx2 were significantly increased by LIPUS exposure compared to controls, whereas BSP, OCN, and OPN mRNA expression could not be detected in HPL cells, irrespective of LIPUS exposure. CONCLUSION: LIPUS enhanced ALP activity, collagen synthesis, and Runx2 expression of HPL cells, which provides important insight into the promotion of early cementoblastic differentiation of immature cementoblasts.

Consequences of viscoelastic behavior in the human temporomandibular joint disc.

The consequences of the viscoelastic behavior of the temporomandibular joint disc were analyzed in simulated jaw open-close cycles. It was hypothesized that viscoelasticity helps protect the underlying bone, while augmenting the smoothness of articular movements. Simulations were performed with a dynamic model of the masticatory system, incorporating the joints' cartilaginous structures as Finite Element Models. A non-linear viscoelastic material model was applied for the disc. The apparent stiffness of the disc to principal stress was largest when the jaw was closed, whereas, with the Von Mises' stress, it appeared largest when the jaw was open. The apparent stiffnesses appeared to be dependent on both the speed of the movements and the presence of a resistance between the teeth. It was concluded that the disc becomes stiffer when load concentrations can be expected. During continued cyclic motion, it softens, which favors smoothness of joint movement at the cost of damage prevention.

Viscoelastic material model for the temporomandibular joint disc derived from dynamic shear tests or strain-relaxation tests.

Viscoelastic material models for the temporomandibular joint disc, based upon strain relaxation, were considered to underestimate energy absorption for loads with time constants beyond the relaxation time. Therefore, the applicability of a material model that takes the viscous behavior at a wide range of frequencies into account was assessed. To that purpose a non-linear multi-mode Maxwell model was tested in cyclic large-strain compression tests. Its material constants were approximated from dynamic small-strain shear deformation tests. The storage and loss moduli as obtained from a disc sample could be approximated with a four-mode Maxwell model. In simulated large-strain compression tests it behaved similarly as observed from the experimental tests. The underestimation of energy dissipation, as obtained from a single-mode Maxwell model was considerably reduced, especially for deformations with a higher strain rate. Furthermore, in contrast to the latter it was able to predict the increase of the stress amplitude with the compression frequency much better. In conclusion, the applied four-mode Maxwell model, based upon dynamic shear tests, was considered more suitable to predict higher frequency viscoelastic response, for instance during shock absorption, than a model based upon strain-relaxation.

The relationship between a dolichofacial morphology and bone adaptation of the articular tubercle.

OBJECTIVES: Against the background of a possibly compromised functional adaptation, the relationship between the height of the articular tubercle was analyzed as a function of the amount of divergence between the maxilla and the mandible. DESIGN: These parameters were obtained retrospectively from orthopantomograms and lateral radiographs produced in a standard procedure before orthodontic treatment. RESULTS: The height of the articular tubercle appeared to be significantly smaller in a group of patients with a dolichofacial morphology, with respect of those with an average (mesofacial) morphology. Furthermore, there was a significant correlation between the height of the articular tubercle and the mandibular angle. CONCLUSIONS: These results suggest that bone remodeling in selected parts of the orofacial skeleton can be compromised giving rise to an altered craniofacial morphology.

Passive resistance increases differentially in various jaw displacement directions.

OBJECTIVES: In the present study, the passive resistance of the human jaw system was quantified in relation to the three-dimensional jaw displacement and the Posselt-envelope, using both in vivo measurements and computer simulation. METHODS: In eight subjects, the jaw was passively displaced with a step-wise increasing force in three orthogonal directions. Muscle relaxation was monitored using electromyography (EMG) with visual feedback. A biomechanical model of an average human system was used to examine the contributions of the jaw muscles. RESULTS: The largest excursion was found for the vertical direction. Protrusive and lateral directions were more restricted. In protrusive and lateral directions, the jaw could generally move beyond the Posselt-envelope. The stiffness of the jaw increased with proceeding jaw displacement in all directions. The stiffness was larger in the protrusive direction than in the vertical and lateral directions. The model's predictions of stiffness were comparable to the in vivo measurements. However, in protrusive direction, the maximum jaw displacement was larger than in vivo. The estimated passive muscle forces showed that vertical displacement was mainly restricted by the complete group of closing muscles, while protrusive and lateral jaw displacement was restricted by selective individual muscles. CONCLUSIONS: The human jaw system has larger motion range in the protrusive and lateral directions than can be exploited by active muscle use. Stiffness of jaw displacement is higher in the protrusive direction compared to the vertical and lateral directions.

How muscle relaxation and laterotrusion resolve open locks of the temporomandibular joint. Forward dynamic 3D-modeling of the human masticatory system.

Patients with symptomatic hypermobility of the temporomandibular joint report problems with the closing movement of their jaw. Some are even unable to close their mouth opening wide (open lock). Clinical experience suggests that relaxing the jaw muscles or performing a jaw movement to one side (laterotrusion) might be a solution. The aim of our study was to assess the potential of these strategies for resolving an open lock and we hypothesised that both strategies work equally well in resolving open locks. We assessed the interplay of muscle forces, joint reaction forces and their moments during closing of mouth, following maximal mouth opening. We used a 3D biomechanical model of the masticatory system with a joint shape and muscle orientation that predispose for an open lock. In a forward dynamics approach, the effect of relaxation and laterotrusion strategies was assessed. Performing a laterotrusion movement was predicted to release an open lock for a steeper anterior slope of the articular eminence than relaxing the jaw-closing muscles, herewith we rejected our hypothesis. Both strategies could provide a net jaw closing moment, but only the laterotrusion strategy was able to provide a net posterior force for steeper anterior slope angles. For both strategies, the temporalis muscle appeared pivotal to retrieve the mandibular condyles to the glenoid fossa, due to its' more dorsally oriented working lines.

Fiber-type composition of the human jaw muscles--(part 1) origin and functional significance of fiber-type diversity.

This is the first of two articles on the fiber-type composition of the human jaw muscles. The present article discusses the origin of fiber-type composition and its consequences. This discussion is presented in the context of the requirements for functional performance and adaptation that are imposed upon the jaw muscles. The human masticatory system must perform a much larger variety of motor tasks than the average limb or trunk motor system. An important advantage of fiber-type diversity, as observed in the jaw muscles, is that it optimizes the required function while minimizing energy use. The capacity for adaptation is reflected by the large variability in fiber-type composition among muscle groups, individual muscles, and muscle regions. Adaptive changes are related, for example, to the amount of daily activation and/or stretch of fibers. Generally, the number of slow, fatigue-resistant fibers is relatively large in muscles and muscle regions that are subjected to considerable activity and/or stretch.

Fiber-type composition of the human jaw muscles--(part 2) role of hybrid fibers and factors responsible for inter-individual variation.

This is the second of two articles about fiber-type composition of the human jaw muscles. It reviews the functional relationship of hybrid fibers and the adaptive properties of jaw-muscle fibers. In addition, to explain inter-individual variation in fiber-type composition, we discuss these adaptive properties in relation to environmental stimuli or perturbations. The fiber-type composition of the human jaw muscles is very different from that of limb and trunk muscles. Apart from the presence of the usual type I, IIA, and IIX myosin heavy-chains (MyHC), human jaw-muscle fibers contain MyHCs that are typical for developing or cardiac muscle. In addition, much more frequently than in limb and trunk muscles, jaw-muscle fibers are hybrid, i.e., they contain more than one type of MyHC isoform. Since these fibers have contractile properties that differ from those of pure fibers, this relatively large quantity of hybrid fibers provides a mechanism that produces a very fine gradation of force and movement. The presence of hybrid fibers might also reflect the adaptive capacity of jaw-muscle fibers. The capacity for adaptation also explains the observed large inter-individual variability in fiber-type composition. Besides local influences, like the amount of muscle activation and/or stretch, more general influences, like aging and gender, also play a role in the composition of fiber types.

Combined finite-element and rigid-body analysis of human jaw joint dynamics.

The jaw joint plays a crucial role in human mastication. It acts as a guidance for jaw movements and as a fulcrum for force generation. The joint is subjected to loading which causes tensions and deformations in its cartilaginous structures. These are assumed to be a major determinant for development, maintenance and also degeneration of the joint. To analyze the distribution of tensions and deformations in the cartilaginous structures of the jaw joint during jaw movement, a dynamical model of the human masticatory system has been constructed. Its movements are controlled by muscle activation. The articular cartilage layers and articular disc were included as finite-element (FE) models. As this combination of rigid-body and FE modeling had not been applied to musculoskeletal systems yet, its benefits and limitations were assessed by simulating both unloaded and loaded jaw movements. It was demonstrated that joint loads increase with muscle activation, irrespective of the external loads. With increasing joint load, the size of the stressed area of the articular surfaces was enlarged, whereas the peak stresses were much less affected. The results suggest that the articular disc enables distribution of local contact stresses over a much wider area of the very incongruent articular surfaces by transforming compressive principal stress into shear stress.

Biomechanical analysis of jaw-closing movements.

This study concerns the complex interaction between active muscle forces and passive guiding structures during jaw-closing movements. It is generally accepted that the ligaments of the joint play a major role in condylar guidance during these movements. While these ligaments permit a wide range of motions, it was assumed that they are not primarily involved in force transmission in the joints. Therefore, it was hypothesized that muscle forces and movement constraints caused by the articular surfaces imply a necessary and sufficient condition to generate ordinary jaw-closing movements. This hypothesis was tested by biomechanical analysis. A dynamic six-degrees-of-freedom mathematical model of the human masticatory system has been developed for qualitative analysis of the contributions of the different masticatory muscles to jaw-closing movements, it was found that the normally observed movement, which includes a swing-slide condylar movement along the articular eminence, can be generated by various separate pairs of masticatory muscles, among which the different parts of the masseter as well as the medial pterygoid muscle appeared to be the most suitable to complete this action. The results seem to be in contrast to the general opinion that a muscle with a forward-directed force component may not be suitable for generating jaw movements in which the condyle moves backward. The results can be explained, however, by biomechanical analysis which includes not only muscle and joint forces as used in standard textbooks of anatomy, but also the torques generated by these forces.

Architecture of the human pterygoid muscles.

Muscle force is proportional to the physiological cross-sectional area (PCSA), and muscle velocity and excursion are proportional to the fiber length. The length of the sarcomeres is a major determinant of both force and velocity. The goal of this study was to characterize the architecture of the human pterygoid muscles and to evaluate possible functional consequences for muscle force and muscle velocity. For the heads of the lateral and medial pterygoid, the length of sarcomeres and of fiber bundles, the PCSA, and the three-dimensional coordinates of origin and insertion points were determined. Measurements were taken from eight cadavers, and the data were used as input for a model predicting sarcomere length and active muscle force as a function of mandibular position. At the closed-jaw position, sarcomeres in the lateral pterygoid (inferior head, 2.83 +/- 0.1 microns; superior head, 2.72 +/- 0.11 microns) were significantly longer than those in the medial pterygoid (anterior head, 2.48 +/- 0.36 microns; posterior head, 2.54 +/- 0.38 microns). With these initial lengths, the jaw angle at which the muscles were capable of producing maximum active force was estimated to be between 5 degrees and 10 degrees. The lateral pterygoid was characterized by relatively long fibers (inferior, 23 +/- 2.7 mm; superior, 21.4 +/- 2.2 mm) and a small PCSA (inferior, 2.82 +/- 0.66 cm2; superior, 0.95 +/- 0.35 cm2), whereas the medial pterygoid had relatively short fibers (anterior, 13.5 +/- 1.9 mm; posterior, 12.4 +/- 1.5 mm) and a large PCSA (anterior, 2.47 +/- 0.57 cm2; posterior, 3.53 +/- 0.97 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

The three-dimensional active envelope of jaw border movement and its determinants.

The sagittal and frontal active envelope of border movement is applied regularly as a clinical tool in functional examinations of the human masticatory system. In contrast, the three-dimensional movement area has hardly been examined. Furthermore, the determinants of this area are not established unambiguously. In the present study, the three-dimensional envelope of incisor movement was predicted with a three-dimensional mathematical model of the human masticatory system, which included the morphology of the system and the fine architecture of its muscles. With this model, the influence of the temporomandibular ligaments and the passive muscle tensions on the envelope were estimated. The predicted three-dimensional active envelope of border movements was limited in horizontal directions, predominantly by the temporomandibular ligaments. The passive tensions of the masticatory muscles influenced, although marginally, its vertical extension. It appeared unlikely that, in a normal situation, active muscle tensions (casu quo muscle reflexes) contribute to the shape of the envelope.

A feedback method to determine the three-dimensional bite-force capabilities of the human masticatory system.

A feedback procedure is described that enables a subject to exert bite forces in certain specified directions during static contraction of the human jaw muscles. The output of a three-dimensional transducer is fed to a computer. The magnitude and direction of the resultant force are computed and visualized by a cross on the screen of the computer terminal. In a bite experiment, the subject is instructed to match this cross with a point on the screen, representing the desired bite-force direction. The procedure allows for determination of the range of possible bite-force directions and magnitudes for various locations on the dental arch and study of the concomitant recruitment patterns of the jaw muscles. Some examples of measurement are given.

Three-dimensional finite element analysis of the cartilaginous structures in the human temporomandibular joint.

While the movability of the human temporomandibular joint is great, the strains and stresses in the cartilaginous structures might largely depend on the position of the mandible with respect to the skull. This hypothesis was investigated by means of static three-dimensional finite element simulations involving different habitual condylar positions. Furthermore, the influence of several model parameters was examined by sensitivity analyses. The results indicated that the disc moved together with the condyle in the anterior direction without the presence of ligaments and the lateral pterygoid muscle. By adapting its shape to the changing geometry of the articular surfaces, the disc prevented small contact areas and thus local peak loading. In a jaw-closed configuration, the influence of 30 degrees variations of the loading direction was negligible. The load distribution capability of the disc appeared to be proportional to its elasticity and was enhanced by the fibrocartilage layers on the articular surfaces.