578911
research-article2015
JDRXXX10.1177/0022034515578911Journal of Dental ResearchTMJ Disorders, Models, and Regenerative Implications
Letters to the Editor
Letter to the Editor: Temporomandibular Joint Disorders’ Impact, Research Models, and Implications for Regenerative Approaches
Journal of Dental Research 2015, Vol. 94(6) 863 © International & American Associations for Dental Research 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0022034515578911 jdr.sagepub.com
A.C. Profeta1
Diagnosis of patients with temporomandibular joint (TMJ) disorders is a challenging problem. Models for the measurement of TMJ health and disease status, diagnostics, and therapeutic effects are necessary for assessment of the value of current and future therapies. An excellent clinical study was recently presented by Chantaracherd et al. to determine the association between advanced stages of TMJ degradation and patientreported outcomes of jaw pain, function, and disability (Chantaracherd et al. 2015). In terms of treatment, aggressive resection is the standard treatment for ankylosis of the TMJ. A multiplicity of reconstructive techniques has been reported. However, no single method has produced uniformly successful results (Muhammad et al. 2013). Within the last 25 years, multiple studies have investigated TMJ characteristics, and while this characterization is not complete, analysis of these data has created a solid foundation for tissue-engineering research. The regeneration of fully functional TMJs requires recapitulation of the biological development of different integrated tissues, with dramatic distinctions in structure and function. Space does not permit a full discussion of this subject here, but suffice it to say that these tissues exhibit distinct gradients across a spatial volume, with each tissue having specific properties and roles, and the ability to work in a synchronized biofunctional manner is necessary if regeneration is to take place. Recent advances may provide a credible surgical alternative to traditional strategies, with the prospect of using suitably engineered resorbable scaffolds, appropriate biochemical signals, and cell transplantation under investigation worldwide (Murphy et al. 2013). Mehrotra et al. furthered this rationale using a hydroxyapatite/collagen scaffold that was carved to the shape of the condyle after gap arthroplasty in young patients with TMJ ankylosis (Mehrotra et al. 2012). All patients showed appreciable improvements in all range of mandibular movements during the postoperative phase. Noteworthy conclusions can be drawn from these initial results: Customizable gradient-based scaffolds have been
reported as a viable option for TMJ reconstruction, allowing for closer reproduction of the normal anatomy, reduced operating time, no donor site morbidity, and fewer complications, as well as improved subjective and objective outcomes. Next-generation tissue-engineering approaches will require the concomitant development of new technologies and methods that can monitor the joint in health, in disease, and in treatment outcomes. Clinical trials on a larger number of patients, with enhanced functional assessment techniques, are needed to strengthen the evidence base before this type of intervention can be recommended for wider implementation.
Acknowledgments The author received no financial support and declares no potential conflicts of interest with respect to the authorship and/or publication of this article.
References Chantaracherd P, John MT, Hodges JS, Schiffman EL. 2015. Temporomandibular joint disorders’ impact on pain, function, and disability. J Dent Res. 94(3 Suppl):79S–86S. Mehrotra D, Kumar S, Dhasmana S. 2012. Hydroxyapatite/collagen block with platelet rich plasma in temporomandibular joint ankylosis: a pilot study in children and adolescents. Br J Oral Maxillofac Surg. 50(8):774–778. Muhammad JK, Al Hashimi BA, Al Mansoor AB, Ali I. 2013. The use of a bioadhesive (BioGlue®) secured conchal graft and mandibular distraction osteogenesis to correct pediatric facial asymmetry as result of unilateral temporomandibular joint ankylosis. Craniomaxillofac Trauma Reconstr. 6(1):49–56. Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. 2013. Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. Int J Oral Maxillofac Implants. 28(6):e393–414.
1
Friedrich-Schiller-University Jena, Jena, Germany
Corresponding Author: A.C. Profeta, Friedrich-Schiller-University Jena, Fraunhoferstr. 6, D-07743 Jena, Germany. Email: andrea.profeta@uni-jena.de
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