Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.

Orthodontic retreatment of an adult woman with mandibular backward positioning and temporomandibular joint disorder:A case report

BACKGROUND The role of occlusal factors on the occurrence of temporomandibular joint disorders(TMDs)is still unclear and it is tricky for orthodontists to treat malocclusions in patients with TMDs.We report the case of the second orthodontic treatment of an adult female with Class II division 2 malocclusion associated with TMD.With the removal of anterior occlusal interference,TMD symptoms were alleviated and cone beam computed tomography(CBCT)images showed the bilateral condyles shifted forward.CASE SUMMARY This case report presented an orthodontic retreatment of an adult female with TMD and mandibular backward positioning based on CBCT examination and Joint Space Index(JSI)analysis.The left and right JSI values of-38.5 and-52.6 indicated that the position of bilateral condyles had posterior displacement.Ten years prior to this evaluation,she underwent orthodontic treatment resulting in the extraction of two upper premolars and one lower central incisor.The joint symptoms,including pain and sounds,were alleviated along with verified mandibular forward repositioning by extraction of another lower central incisor.CONCLUSION Mandibular backward positioning could be associated with TMD.JSI analysis based on CBCT is a convenient way to examine condylar positions quantitatively.

Future of Treatment of Temporomandibular Joint Dysfunctions in Parkinsonian Patients

The purpose of the study was designed to clarify the modern trends of physical therapy in treatment of temporomandibular joint dysfunctions in Parkinsonian patients, which in this respect included the degree of pain, the muscles power of both masseter and pterygoid, the range of TMJ motion, the angle of mouth opening and their effects on electromyography study in both sexes. Subjects: Thirty males and females were the same degree of disabilities according to modified Hoehn and Yahr scales (grade 3) of Parkinsonian patients, and their age ranged from 50 - 77 years old and their weight ranged from 60 - 88 kg. They were randomly divided into two equal groups (G1 and G2). G1 (control) consisted of 15 patients of both sexes and was treated by exercises therapy program and G2 (experimental) consisted of 15 Parkinsonian patients of both sexes and was treated by the same exercises therapy program and low level pulsed electromagnetic therapy. Vital signs such as blood pressure, body temperature, pulse rate and respiratory rate were measured before and after the treatment sessions. Assessments: Visual analogue scale was used to measure degree of pain. Tensiometer was used to measure the muscle power of masseter and pterygoid, the digital goniometer was used to investigate the range of TMJ movement. Moreover, standard electromyography test (EMG) was used to measure the compound muscle action potentials. Statistically the results for all groups were analyzed by t-test to compare the differences between the two groups. The statistical package of social sciences (SPSS, version 10) was used for data processing using the P-value 0.05 as a level of significance. Results showed that there were significant improvements in all variables in G2 only. However, there was a little improvement but not significant in both G1. Therefore, it could be concluded that the use of low level pulsed electro-magnetic therapy combined with exercises program was the good method to control pain of TMJ, increase of muscle power and the range of their movements together with determination of electro-myography. Our results opened a new link to manage the TMJ dysfunctions in Parkinsonian patients via the use of low level pulsed electromagnetic therapy combined with exercises program.

Multidetector computed tomography of temporomandibular joint: A road less travelled

This article reviews the imaging anatomy of temporomandibular joint(TMJ), describes the technique of multi-detector computed tomography(MDCT) of the TMJ, and describes in detail various osseous pathologic afflictions affecting the joint. Traumatic injuries affecting the mandibular condyle are most common, followed by joint ankylosis as a sequel to arthritis. The congenital anomalies are less frequent, hemifacial microsomia being the most commonly encountered anomaly involving the TMJ. Neoplastic afflictions of TMJ are distinctly uncommon, osteochondroma being one of the most common lesions. MDCT enables comprehensive evaluation of osseous afflictions of TMJ, and is a valuable tool for surgical planning. Sagittal, coronal and 3D reformatted images well depict osseous TMJ lesions, and their relationship to adjacent structures.

Imaging of the temporomandibular joint: An update

Imaging of the temporomandibular joint(TMJ) is continuously evolving with advancement of imaging technologies. Many different imaging modalities are currently used to evaluate the TMJ. Magnetic resonance imaging is commonly used for evaluation of the TMJ due to its superior contrast resolution and its ability to acquire dynamic imaging for demonstration of the functionality of the joint. Computed tomography and ultrasound imaging have specific indication in imaging of the TMJ. This article focuses on state of the art imaging of the temporomandibular joint. Relevant normal anatomy and biomechanics of movement of the TMJ are discussed for better understanding of many TMJ pathologies. Imaging of internal derangements is discussed in detail. Different arthropathies and commontumors are also discussed in this article.

Dental Treatment for Dizziness and Joint Mobility Disorder Caused by Harmful Electromagnetic Waves

With the development of an IT (Information Technology) society, the opportunity to use electronic devices, such as cell phones and personal computers, has increased. These electronic devices pro-vide many benefits to society. However, there have been a number of reports of electromagnetic hypersensitivity (EHS) related to the use of electronic devices. The symptoms of EHS may include headaches, fatigue, tinnitus, dizziness, memory loss, irregular heartbeat, and skin trouble. Since the pathogenic mechanism of such conditions is not yet clear, further research is required. This report shows how a subject’s dizziness and joint mobility disorder, caused by electromagnetic waves emitted by electronic devices, were cured by removing an onlay from the patient’s mouth and replacing it with a gold alloy onlay. The result indicates that the subject’s symptoms were caused by EHS. Although the symptoms were improved after the dental treatment, the underlying mechanism of the symptoms and the reason why this treatment is successful remain unclear. Further research is required to clarify these issues.

实验性间接性颞下颌关节损伤的高分辨率CT研究

目的 建立间接性颞下颌关节损伤（ＴＭＪＩ）动物模型，探讨ＣＴ在 ＴＭＪＩ诊断中的应用。方法 对成功的１８只 ＴＭＪＩ模 型兔．用ＧＥ９８００ＣＴ机按设计的分组方法进行１．５ｍｍ薄层连续冠状面扫描，用一种不同窗宽／窗位观察并进行关节盘区ＣＴ值 测量、结果 骨窗显示骨折好，重建前后区别不大。软组织窗显示ＴＭＪ脂肪囊好。Ｄｅｔａｉｌ窗显示关节盘好，而且关节盘区最佳窗宽／ 窗位为４００ Ｈｕ／１００ Ｈｕ。ＴＭＪ脂肪囊内不均匀高密度为ＣＴ诊断关节盘破裂时具有特征的间接征象。ＴＭＪＩ实验组ＣＴ值高于对照 组（Ｐ＜０．０１）。而在不同时间相比，伤后１Ｗ实验组ＣＴ值高于对照组（Ｐ＜０．０５）。结论 ＣＴ对ＴＭＪＩ的骨折及关节盘区软组织改 变显示优越。 一定程度上也可显示关节盘破裂。

Septic Arthritis of the Temporomandibular Joint without an Apparent Source of Infection: A Case Report

Septic arthritis of the temporomandibular joint (TMJ) is a rare disease that is characterized by preauricular pain, edema, malocclusion, trismus and abscess formation in the TMJ region. An 85-year-old male visited our hospital with the complaint of left-sided TMJ swelling, pain and trismus. Septic arthritis of the left TMJ was diagnosed on the basis of considerable elevation of CRP (Creactive proteins) and CT imaging findings. The patient was treated with oral Faropenem at 450 mg daily, but CRP increased three days after the initial visit. He was hospitalized and treated with intravenous administration of cefazolin at 2 g and clindamycin at 1.2 g daily for six days. Propionibacterium species and Veillonella species grew in a culture of the joint aspirate, but there was no apparent source of infection. After acute infectious symptoms had passed, the patient was treated with oral amoxicillin at 750 mg daily for eight weeks and was instructed to do jaw opening exercise. The patient was discharged on the 11th hospital day. After three weeks of the hospital discharge, the patient healed completely. To avoid serious complications, clinicians should include septic arthritis of the TMJ in the differential diagnosis of preauricular pain, trismus and swelling.

基于网络药理学和分子对接研究高山金莲花素对颞下颌关节骨关节炎细胞模型的作用机制

目的运用网络药理学与分子对接方法探讨高山金莲花素(alpinumisoflavone,AIF)对颞下颌关节骨关节炎(temporomandibular joint osteoarthritis,TMJOA)细胞模型的作用机制,为AIF治疗TMJOA提供研究基础。方法运用GeneCards、OMIM、DisGeNET和PharmGKB数据库获取TMJOA疾病靶点,PharmMapper和HERB获取AIF作用靶点,取化合物与疾病交集靶点上传至STRING数据库得到关键靶点后做GO和KEGG富集分析,分子对接评估相关信号通路中关键靶点。获得医院伦理委员会的审批,提取3周龄SD大鼠髁突软骨细胞。CCK8检测AIF对髁突软骨细胞的毒性。用10 ng/mL白细胞介素⁃1β(interleukin 1β,IL⁃1β)诱导髁突软骨细胞24 h构建TMJOA细胞模型。实验分为3组,其中,对照组:DMEM培养基培养髁突软骨细胞48 h;IL⁃1β组(TMJOA细胞模型):预使用DMEM培养基培养髁突软骨细胞24 h后,保留原培养基的情况下加入IL⁃1β使终浓度达10 ng/mL继续培养24 h;IL⁃1β+10μmol/L AIF组:预使用含10μmol/L AIF的DMEM培养基培养髁突软骨细胞24 h,保留原培养基情况下加入IL⁃1β使终浓度达10 ng/mL继续培养24 h,流式细胞术检测AIF对TM⁃JOA细胞模型中的髁突软骨细胞凋亡的影响。进一步,实验分为对照组、IL⁃1β组、IL⁃1β+10μmol/L AIF组和IL⁃1β+30μmol/L AIF组共4组,其中,IL⁃1β+30μmol/L AIF组:预使用含30μmol/L AIF的DMEM培养基培养24 h,保留原培养基情况下加入IL⁃1β使终浓度达10 ng/mL继续培养24 h;其余3组方法同前。以qPCR与Western blot分别检测AIF对TMJOA细胞模型中与细胞凋亡相关的B淋巴细胞瘤2(B⁃cell leukemia/lymphoma⁃2,Bcl2)、天冬氨酸特异的半胱氨酸蛋白酶3(cysteinyl aspartate specific protease 3,Caspase⁃3)及基质降解相关的解聚蛋白样金属蛋白酶4(a disintegrin and metalloproteinase with thrombospondin motifs 4,ADAMTS4)、基质金属蛋白酶3(matrix metalloproteinase 3,MMP3)和基质金属蛋白酶13(matrix metalloproteinase 13,MMP13)mRNA和蛋白的表达。结果PharmMapper与HERB数据库检索得到AIF化合物靶点300个,GeneCards、OMIM、DisGeNET和PharmGKB数据库检索得到TMJOA疾病靶点378个,将化合物与疾病靶点交集得33个潜在靶点,将其上传至STRING数据库得31个关键靶点,主要与细胞凋亡和细胞外基质降解相关。这一过程可能涉及丝裂原活化蛋白激酶(mitogen⁃activated protein kinase,MAPK)、雌激素及肿瘤坏死因子(tumor necrosis factor,TNF)等信号通路。分子对接结果表明AIF与MAPK和雌激素信号通路中的关键靶点细胞外信号调节激酶1/2(extracellular sig⁃nal⁃regulated kinase 1/2,ERK1/2)和雌激素受体基因1/2(estrogen receptor gene 1/2,ESR1/2)具有较好的结合活性。CCK8结果表明AIF对髁突软骨细胞无明显细胞毒性。与IL⁃1β组相比,IL⁃1β+10μmol/L AIF组中AIF可抑制髁突软骨细胞凋亡;与IL⁃1β组相比,IL⁃1β+10μmol/L AIF组和IL⁃1β+30μmol/L AIF组中AIF可上调Bcl2和下调Caspase⁃3 mRNA和蛋白表达,抑制ADAMTS4、MMP3和MMP13 mRNA和蛋白表达。结论AIF可通过上调Bcl2与下调Caspase⁃3 mRNA和蛋白表达抑制TMJOA细胞模型中髁突软骨细胞凋亡,同时抑制由IL⁃1β诱导的细胞外基质降解,延缓TMJOA进展。

5-HT、NPY与TMD患者关节源性疼痛关系的研究

目的 探讨TMD患者关节液中5 -HT和NPY的水平与关节源性疼痛的关系。方法 用ELISA法检测TMD患者的1 2 6侧关节和健康志愿者的32侧关节的关节液标本中的5 -HT ,用放射免疫测定法检测关节液标本中NPY的含量。1 2 6侧TMD患者的关节液标本分为疼痛组(n =90 )和无痛组(n =36 ) ;32名正常志愿者的32侧关节液设为对照组(n =32 )。结果 所有标本都检出5 -HT ,无痛组含量为1 78.75 0±6 4 .979ng/ml,疼痛组含量为2 2 3.5 2 2±82 .6 36ng/ml,对照组含量为1 36 .1 2 5±5 5 .0 75ng/ml。统计学检验:疼痛组与无痛组、疼痛组与对照组以及无痛组与对照组间比较均有显著性差异(P <0 .0 5 )。NPY检测结果:疼痛组1 33.5 0 0±4 6 .6 6 4 pg/ml,无痛组99.6 5 6±2 5 .873pg/ml,对照组83.2 86±2 8.397pg/ml。统计学检验:疼痛组与无痛组、疼痛组与对照组以及无痛组与对照组间比较均有显著性差异(P <0 .0 5 )。结论 关节液中5 -HT、NPY的水平,患者组显著高于正常人组,并且在患者中疼痛组又显著高于无痛组,表明患者关节内存在炎症状态,也表明关节疼痛与关节液中5 -HT、NPY的水平增高密切相关。

Evaluating the effects of pain and disorders of the knee joint on knee extension strength and daily life activities in the female elderly

This study aimed at examining the differences in leg strength and activities of daily living (ADL) ability among groups with various knee problems. The subjects consisted of 328 elderly females who were classified into three groups: those without knee pain or a knee disorder, those with knee pain, and those with a knee disorder. The subjects took a knee extension strength test and an ADL survey. Knee extension strength and ADL scores (total score and each domain score of the motions of locomotion, posture change, stability, and manipulation) were selected as the evaluation parameters. The knee extension strength, total ADL score and each domain score of the motions of locomotion, posture change, and stability ranged from low to high in the following order: the group with a knee disorder, the group with knee pain, and the group without pain or a knee disorder. Moreover, manipulation scores were significantly inferior in the group with a knee disorder compared with the other two groups. In conclusion, the female elderly with knee pain or a knee disorder have inferior knee extension strength and ADL with respect to the motions of locomotion, posture change and stability. In addition, with regard toknee extension strength with respect to theabove three motions, the elderly with a knee disorder have inferior scores when compared with the elderly who have only knee pain;thus, they find it difficult to perform activities involving the knee joints.

Distribution of pericellular matrix molecules in the temporomandibular joint and their chondroprotective effects against inflammation

The objectives of this study were to （1） determine the distribution and synthesis of pericellular matrix （PCM） molecules （collagen VI, collagen IV and laminin） in rat temporomandibular joint （TMJ） and （2） investigate the effects of PCM molecules on chondrocytes against inflammation in osteoarthritis. Four zones （fibrous, proliferating, mature and hypertrophic） of condylar cartilage and three bands （anterior, intermediate and posterior） of disc were analysed by immunohistochemistry for the presence of PCM molecules in rat TMJs. Isolated chondrocytes were pre-treated with PCM molecules before being subjected to interleukin （IL）-II~ treatment to stimulate inflammation. The responses of the chondrocytes were analysed using gene expression, nitric oxide release and matrix metalloproteinase （MMP）-13 production measures. Histomorphometric analyses revealed that the highest areal deposition of collagen VI （67.4%）, collagen IV （45.7%） and laminin （52.4%） was in the proliferating zone of TMJ condylar cartilage. No significant difference in the distribution of PCM molecules was noted among the three bands of the TMJ disc. All three PCM molecules were expressed intracellularly by chondrocytes cultured in the monolayer. Among the PCM molecules, pre-treatment with collagen VI enhanced cellular proliferation, ameliorated IL-lp-induced MMP-3, MMP-9, MMP-13 and inducible nitric oxide synthase gene expression, and attenuated the downregulation of cartilage matrix genes, including collagen I, aggrecan and cartilage oligomeric matrix protein （COMP）. Concurrently, collagen VI pretreatment inhibited nitric oxide and MMP-13 production. Our study demonstrates for the first time the distribution and role of PCM molecules, particularly collagen VI, in the protection of chondrocytes against inflammation.

High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?

AIM To investigate the prevalence and the risk of temporomandibular disorders(TMDs)in patients with irritable bowel syndrome(IBS)(including each subtype:constipation,diarrhoea,and mixed)compared to the general population.METHODS Between January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls(HC)without IBS.At enrollment,we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD.RESULTS We enrolled 91 IBS patients(23 IBS-D,30 IBS-C and38 IBS-M)and 57 HC in the study.We found a higher risk of having TMD(OR=3.41,95%CI:1.66-7.01)compared to the HC.The risk of having TMD was independent of IBS-subtype.Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression.CONCLUSION IBS patients had a more than three times greater risk of TMD compared to HC.The risk of having TMDwas similar in different IBS subtypes.IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.Key words:Temporomandibular disorders;Irritable bowel syndrome;Chronic pain;Facial pain;Abdominal pain;Irritable bowel syndrome severity score symptoms;Irritable bowel syndrome predominant diarrhea;Irritable bowel syndrome predominant constipation;Irritable bowel syndrome mixed?The Author(s)2017.Published by Baishideng Publishing Group Inc.All rights reserved.

Subconscious temporomandibular dysfunction therapy: A new therapeutic approach for temporomandibular disorders

AIM: To evaluate a new therapeutic approach that may permanently address excessive involuntary muscle activity which causes temporomandibular disorders(TMD). METHODS: A cohort of 69 TMD patients(33 men and 36 women, age range 14-71 years) was treated with Subconscious Temporomandibular Dysfunction(STe Dy) therapy. A thick awareness splint assisted patients to gradually recognize the interdependence between psychological pressure and subconscious muscle activity. The STe Dy therapy lasted for one year and involved three stages:(1) data collection including medical history, clinical examination and psychological evaluation;(2) application of the awareness splint and consultation on a monthly basis; and(3) final evaluation.RESULTS: About 10% of patients(3 men and 4 women) quit the STe Dy therapy within the first 3-6 modue to severe health problems or psychosocial reasons. Based on the absence of objective and subjective clinical symptoms as well as on radiographic findings, the temporomandibular dysfunction treatment was successful in all remaining 62 patients that completed the year-long therapy. Symptoms, including recurrent headache, morning fatigue, clicking sound or painful temporomandibular joint disorders, were eliminated in all patients within the first six months. By completion of the STe Dy therapy, all patients had learned to recognize stressful conditions and cognitively avoided displaying excessive bruxism or other subconscious activity of the stomatognathic muscles. A follow-up after at least one year indicated the permanent nature of the cognitive treatment in all patients, illustrating the fact that subconscious muscle activity due to stress plays a principal role in the great majority of TMD, at least in adults.CONCLUSION: The STe Dy therapy successfully and permanently resolved TMD problems of all patients that completed the year-long treatment.

Survey of Temporomandibular Disorder in Male Candidates of Conscription Age

[Objectives] To study the temporomandibular disorder(TMD) in male candidates of conscription age. [Methods] The TMD was surveyed in 2 152 young males who participated in 2015, 2016 and 2017 physical examinations for conscription in Qingzhou City, Weifang of Shandong Province. [Results] Cases with previous positive symptoms and with positive clinical signs respectively accounted for 5.02% and 18.91% of the whole respondents. Among the three major symptoms, the occurrence of clicking, accounting for 17.7% of the total case amount, ranked the first; among 407 cases with positive clinical signs, the top two symptoms were simple clicking(50.86%) and clicking with abnormal mandibular movement(36.85%). [Conclusions] TMD occurs in male candidates of conscription age with a relatively high occurrence, but most cases are mild with clicking as the major symptom.

颞下颌关节区滑膜软骨瘤病的CT诊断

目的 探讨颞下颌关节区滑膜软骨瘤病在CT上的表现特点。资料与方法 搜集9例主诉为单侧颞下颌关节区肿胀患者的CT轴位和冠状位扫描,并对其CT表现进行评价。所有病例均经关节镜或手术病理证实为滑膜软骨瘤病。结果 颞下颌关节滑膜软骨瘤病的CT表现为:(1)关节区软组织肿大(n =8) ;(2 )病变内有散在钙化小体(n =8) ;(3)关节间隙增宽(n =4 ) ;(4)下颌髁突骨质异常改变(n =3) ;(5 )颞骨关节面骨质异常改变(n =6 ) ,其中CT表现为颞骨关节面骨质硬化者4例,颞骨关节面骨质吸收者3例,颞骨关节面骨质变薄者1例。1例CT检查显示滑膜软骨瘤病向上经颞骨关节面侵犯颅内(大脑颞叶脑膜)。结论 颞下颌关节滑膜软骨瘤病的CT表现以该区软组织肿胀伴散在的钙化小体和周围骨质受侵犯为特征。后者可以引起中颅窝底的破坏和颅内侵犯,进而影响病变的预后。

Topology Optimization and Fatigue Analysis of Temporomandibular Joint Prosthesis

Treatment of bone tumors in the mandible often involves extensive excavation of affected bone, followed by mandibular reconstruction. Prosthetic implants may be needed to restore jaw functionality. The challenges of making prosthetic bone implants include stress shielding and extending the mechanical life of the implant. We have developed a design algorithm to improve the efficiency of prosthesis design. A finite element model of the patient case is constructed from a computer tomography scan, and the computer implements topology optimization techniques to design the prosthesis with limited stress shielding affected by highly biomechanical compatibility. Topology optimization facilitates the design of low weight structures by automatically introducing holes into the structure. This is governed by engineering predetermined constraints to meet certain job specifications. Such a design will be tested for fatigue life before it is ready to be manufactured and used. Topology optimization can be performed as a design process to achieve a final design that takes stress shielding into consideration. The problem of stress shielding is solved by matching the stiffness of the orthopedic implant to the original bone that is being replaced. The material we used was titanium alloy (Ti-6Al-7Nb). Volume fraction of the orthodox implant was used (0.2872 for the studied case) as volume constraints. Compliance of the bulk bone was set as a further constraint to match the stiffness of the bone with the designed structure. Our results show a good life expectancy for the designed parts, with 12% higher life expectancy for stress-based topology optimization than for compliance-based topology optimization.

Rheumatoid Arthritis of the Temporomandibular Joint;Comparison of Digital Panoramic Radiographs Taken Using the Joint Limitation Program [JLA View] and CT Scans

Objective: The aim of this study was to evaluate the efficacy of digital panoramic radiographs using the JLA view pro-gram in cases of rheumatoid arthritis and compare them to CT scans of the patients. Methods: 40 patients with known condition of RA and clinical symptoms in the TMJ were selected for the study. Radiological evaluation included a panoramic radiograph of the TMJs that was taken and a computer tomography of the joints. In the panoramic radio-graphs taken, isolation of the TMJs was done using the JLA view program, while in the CT scans of the patients, all scans were taken with closed mouth, with a distance of 0.5 mm per slice. The parameters examined were: 1) Bony changes of the condyle;2) The position of the condyle in the mandibular fossa;3) The joint space;4) Bony changes of mandibular fossa. Results: There were no statistically significant differences found between the two observers or be-tween the two joints of the same patient [right and left] on the panoramic radiographs. For the case of CT scans there were significant differences between the joint space of right and left joints, while in the ANOVA performed differences were found for the evaluation of the bony changes of the condyle. Conclusion: There were no significant differences between the two radiographic methods selected and therefore when a proper simple radiograph is taken and well evalu-ated, the conclusions drawn from it are well based and there is no need for further