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DEGENERATIVE CHANGES OF THE HUMAN TEMPOROMANDIBULAR JOINT: A radiological, microscopical, histomorphometrical and biochemical study.

Flygare, Lennart LU (1997) In Swedish Dental Journal Supplement 120.
Abstract (Swedish)
Popular Abstract in Swedish

I fem autopsistudier undersöktes humana käkledspreparat med tomografi (skiktröntgen), makroskopiskt (inspektion) och mikroskopiskt för förekomst av degenerativa (nedbrytande) förändringar. Speciellt undersöktes förekomst av erosiva förändringar i benet samt förändringar i den förkalkade broskzonen (skiktet mellan mjukbrosk och ben).



Det förkalkade brosket var i normala fall avgränsat mot överliggande mjukbrosk av en jämn basofil vågig linje, den s.k. tidemark. Avgränsningen mot benet var oregelbunden. Ett samband fanns mellan tjockleken på det "mjuka" brosket och det förkalkade brosklagret. Detta tyder på att den förkalkade broskzonen är en biologiskt aktiv zon även hos vuxna... (More)
Popular Abstract in Swedish

I fem autopsistudier undersöktes humana käkledspreparat med tomografi (skiktröntgen), makroskopiskt (inspektion) och mikroskopiskt för förekomst av degenerativa (nedbrytande) förändringar. Speciellt undersöktes förekomst av erosiva förändringar i benet samt förändringar i den förkalkade broskzonen (skiktet mellan mjukbrosk och ben).



Det förkalkade brosket var i normala fall avgränsat mot överliggande mjukbrosk av en jämn basofil vågig linje, den s.k. tidemark. Avgränsningen mot benet var oregelbunden. Ett samband fanns mellan tjockleken på det "mjuka" brosket och det förkalkade brosklagret. Detta tyder på att den förkalkade broskzonen är en biologiskt aktiv zon även hos vuxna individer.



Två typer av erosiva benförändringar kunde urskiljas. En typ där det överliggande brosket var intakt och en typ där det överliggande brosket var s.g.s. helt bortskalat. Den senare typen av förändring fanns i större antal i condylen (käkledshuvudet), medan förändringarna i den temporala ledkomponenten (ledhålan i skallbasen) oftare var av den första typen och mindre utbredda. Detta kan tyda på en skillnad i biologisk reaktion mellan de båda ledkomponenterna.



Skiktröntgen undervärderade både antalet och utbredningen av de erosiva förändringarna. Positiva prediktiva värden (d.v.s. sannolikheten att ett röntgenfynd av en erosion verkligen motsvaras av en erosion) var 70% i kondylen och 91% i den temporala komponenten. Negativa prediktiva värden (d.v.s. sannolikheten att ytor som ser friska ut på röntgen verkligen är det) var 83% i condylen och 68% i den temporala komponenten.



Tre olika tekniker för benvolymsbestämning med hjälp av databaserad bildanalys utvärderades, en automatisk, en manuell och en semi-automatisk. Den semi-automatiska tekniken gav en god reproducerbarhet och liten variation när man använde sig av endast en operatör.



Den semi-automatisk tekniken användes för att mäta benvolymen i käkledspreparaten. Käkledskondyler med erosiva förändringar visade sig generellt vara tätare i benet än käkleder utan förändringar. Detta talar för att bentätheten spelar en roll i uppkomsten av erosiva förändringar i käkleden.



I en klinisk studie undersöktes ledvätskan från patienter som fick käkledsdisken bortopererad. Prover på käkledsvätskan togs dels vid operationen och 6 månader efter operationen. Proverna analyserades avseende förekomst av fragment av två olika broskmolekyler Aggrecan och COMP. Dessa molekylerna finns normalt i ledbrosket och "läcker ut" i ledvätskan när brosket skadas. Det visade sig att ration (förhållandet) mellan Aggrecan/COMP var högre i alla ledvätskorna vid 6-månaderskontrollen. Vid denna kontroll uppvisade dessutom samtliga leder benförändringar av degenerativ karaktär (på röntgen). Detta talar för att man eventuellt kommer att kunna spåra tidiga broskskador i käkleden genom att analysera ledvätskan. Tekniken måste dock först förfinas både vad avser provtagning och den biokemiska analysen. (Less)
Abstract
In five autopsy specimen studies human temporomandibular joints were investigated by conventional tomography, macroscopy, and microscopy for degenerative changes, in particular erosive hard-tissue changes.In the microscopical evaluation special attention was paid to the calcified cartilage.



The calcified cartilage was outlined by a flat or gently undulating basophilic tidemark and an irregular osteochondral junction. A significant correlation was found between the thickness of the calcified cartilage and that of the total articular cartilage.



Two types of erosive changes were found; an extensive type with complete loss of overlying cartilage and a local type with retained cartilage. The erosive changes... (More)
In five autopsy specimen studies human temporomandibular joints were investigated by conventional tomography, macroscopy, and microscopy for degenerative changes, in particular erosive hard-tissue changes.In the microscopical evaluation special attention was paid to the calcified cartilage.



The calcified cartilage was outlined by a flat or gently undulating basophilic tidemark and an irregular osteochondral junction. A significant correlation was found between the thickness of the calcified cartilage and that of the total articular cartilage.



Two types of erosive changes were found; an extensive type with complete loss of overlying cartilage and a local type with retained cartilage. The erosive changes were generally more extensive in the condyle. Microscopically, the erosive changes in the condyle were evenly distributed. In the temporal component there was a slight predominance of these changes located to the lateral part of the tubercle. Tomography underestimated both the presence and the extent of the erosive changes. Positive predictive values and negative predictive values were 0.70 and 0.83, respectively, for changes in the condyle and 0.91 and 0.68 for changes in the temporal component. The likelihood ratio for a positive test was 10.6 in the temporal component and 5.6 in the condyle. The likelihood ratio for a negative test was comparable in the two joint components 0.49 and 0.47 respectively.



Three different techniques of computer-aided bone histomorphometry (manual, automatic and semi-automatic) were assessed. The variation when assessing the total and trabecular bone volume was evaluated. Good reproducibility in the assessment of the total and trabecular bone volume was achieved with the aid of a single observer and a semi-automatic technique. This technique was therefore used to assess the total and trabecular bone volume in condyles and temporal components of joints with and without microscopically verified erosive changes. Condyles with erosive changes demonstrated both a higher trabecular bone volume (P< 0.05) and higher total bone volume (P< 0.01) than condyles without erosive changes.



In a clinical study on patients undergoing diskectomy, the two cartilage matrix macromolecules aggrecan and cartilage oligomeric matrix protein (COMP) were quantified by enzyme-linked immunosorbent assay in lavage fluids from temporomandibular joints before and six months after surgery. The aggrecan/COMP ratio was higher in the lavage fluid of all joints at follow-up as compared to preoperatively. All joints developed radiographic changes indicative of degenerative changes (osteoarthrosis) during the postoperative period. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Associate Professor Isacsson, Göran, The Karolinska Institute, Huddinge
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Temporomandibular Joint Diseases, Synovial Fluid, Proteoglycans, Osteoarthritis, Observer variation, Microscopy, Bone density, Diagnostic properties, Image processing, Tomography, X-ray, Odontology, stomatology, Odontologi
in
Swedish Dental Journal Supplement
volume
120
pages
148 pages
publisher
Swedish Dental Journal
defense location
The Faculty of Odontology, Malmö
defense date
1997-03-14 10:15
external identifiers
  • other:ISRN: SE-LUODD5/ODOR-97/1001+148p
  • scopus:0030640162
ISSN
0348-6672
ISBN
91-628-2376-0
language
Other
LU publication?
yes
id
d5e3ac05-c987-41b5-8de7-48c0d7161bb1 (old id 29020)
date added to LUP
2007-06-14 13:15:03
date last changed
2017-08-20 04:18:36
@phdthesis{d5e3ac05-c987-41b5-8de7-48c0d7161bb1,
  abstract     = {In five autopsy specimen studies human temporomandibular joints were investigated by conventional tomography, macroscopy, and microscopy for degenerative changes, in particular erosive hard-tissue changes.In the microscopical evaluation special attention was paid to the calcified cartilage.<br/><br>
<br/><br>
The calcified cartilage was outlined by a flat or gently undulating basophilic tidemark and an irregular osteochondral junction. A significant correlation was found between the thickness of the calcified cartilage and that of the total articular cartilage.<br/><br>
<br/><br>
Two types of erosive changes were found; an extensive type with complete loss of overlying cartilage and a local type with retained cartilage. The erosive changes were generally more extensive in the condyle. Microscopically, the erosive changes in the condyle were evenly distributed. In the temporal component there was a slight predominance of these changes located to the lateral part of the tubercle. Tomography underestimated both the presence and the extent of the erosive changes. Positive predictive values and negative predictive values were 0.70 and 0.83, respectively, for changes in the condyle and 0.91 and 0.68 for changes in the temporal component. The likelihood ratio for a positive test was 10.6 in the temporal component and 5.6 in the condyle. The likelihood ratio for a negative test was comparable in the two joint components 0.49 and 0.47 respectively.<br/><br>
<br/><br>
Three different techniques of computer-aided bone histomorphometry (manual, automatic and semi-automatic) were assessed. The variation when assessing the total and trabecular bone volume was evaluated. Good reproducibility in the assessment of the total and trabecular bone volume was achieved with the aid of a single observer and a semi-automatic technique. This technique was therefore used to assess the total and trabecular bone volume in condyles and temporal components of joints with and without microscopically verified erosive changes. Condyles with erosive changes demonstrated both a higher trabecular bone volume (P&lt; 0.05) and higher total bone volume (P&lt; 0.01) than condyles without erosive changes.<br/><br>
<br/><br>
In a clinical study on patients undergoing diskectomy, the two cartilage matrix macromolecules aggrecan and cartilage oligomeric matrix protein (COMP) were quantified by enzyme-linked immunosorbent assay in lavage fluids from temporomandibular joints before and six months after surgery. The aggrecan/COMP ratio was higher in the lavage fluid of all joints at follow-up as compared to preoperatively. All joints developed radiographic changes indicative of degenerative changes (osteoarthrosis) during the postoperative period.},
  author       = {Flygare, Lennart},
  isbn         = {91-628-2376-0},
  issn         = {0348-6672},
  keyword      = {Temporomandibular Joint Diseases,Synovial Fluid,Proteoglycans,Osteoarthritis,Observer variation,Microscopy,Bone density,Diagnostic properties,Image processing,Tomography,X-ray,Odontology,stomatology,Odontologi},
  language     = {mis},
  pages        = {148},
  publisher    = {Swedish Dental Journal},
  school       = {Lund University},
  series       = {Swedish Dental Journal Supplement},
  title        = {DEGENERATIVE CHANGES OF THE HUMAN TEMPOROMANDIBULAR JOINT: A radiological, microscopical, histomorphometrical and biochemical study.},
  volume       = {120},
  year         = {1997},
}