Among the temporomandibular joint diseases, osteoarthritis is confirmed by imaging diagnosis. Compared with the usual panoramic radiographs, panoramic TMJ (temporomandibular joint) radiographs taken at the maximum mouth opening can avoid overlapping of the mandibular head and the temporal bone. Therefore it makes easy to evaluate the bone change of the temporomandibular joint. The purpose of the study was to help improve the accuracy of clinical diagnosis of osteoarthritis by primary dental institutions using the panoramic TMJ radiographs.

The image findings of bone change (erosion, osteophyte and atrophy) proposed by The Japanese Society for Temporomandibular Joint were compared with panoramic TMJ radiographs and MR images, and typical image findings of TMJ (normal and osteoarthritis) are clarified.

Both psychological and physical factors are considered to contribute to temporomandibular disorders (TMDs). However, psychological factors are more difficult to objectively evaluate than physical factors in TMDs. The aim of this study was to assess the psychological factors of ego state affecting the duration of symptoms of temporomandibular disorders. The study participants consisted of 236 patients (174 women, 62 men) newly visiting for TMDs following medical examination at the temporomandibular joint clinic of the Niigata University Medical and Dental Hospital during 2010. We analyzed the participants' ego states using the Egogram checklist (ECL). The ECL is a tool for objectively diagnosing ego state and is based on a transactional analysis theory.

Using the Japanese TMD symptom type classification (2001), the patients were classified by three specialists. We examined ego state (CP/NP style, FC/AC style), sex, age, TMD diagnosis, and duration of symptoms in all patients. Logistic regression analysis was used for statistical analysis. Statistically significant differences were indicated by a p-value of less than 0.05. FC<AC style and female sex were factors contributing to TMD symptoms that persisted for a long time of more than six months (p<0.05).

Matrix metalloproteinase (MMP) plays a central role in tissue destruction of inflammatory joint disease. This study investigated gene expression of MMP-1, -3 and tissue inhibitors of metalloproteinase (TIMP) and protein production of MMP-1 and -3 in fibroblast-like synoviocytes (FLS) stimulated with TNF-α.

Method: Human synovial tissue was obtained from patients with internal derangement who underwent arthroscopy of the temporomandibular joint. FLSs were prepared from the tissues using the outgrowth method. TNF-α was added to the cells in culture. Gene expression profiling was performed using microarray analysis. Gene expression was examined using real-time PCR. Protein production was measured using enzyme-linked immunosorbent assay. APMA was used for the activation of pro-MMP-1.

Results: In microarray analysis of synovial cells, MMP-1 and -3 were recognized in the upregulated genes by TNF-α treatment. The gene expression of MMP-1 and -3 was also increased in FLS treated with TNF-α using real-time PCR. On the other hand, the genes of TIMP-1, -2 and -3 in FLS were constitutively expressed. The protein productions of pro-MMP-1 and MMP-3 increased in FLS treated with TNF-α. Although the level of active-MMP-1 in the conditional medium was below the measurement limit of ELISA Kit, the level of active-MMP-1 was increased in the conditional medium of FLS stimulated with TNF-α by APMA treatment.

Conclusion: TNF-α increased MMP-1 and -3 gene expression and pro-MMP-1 protein production in FLS.

The patient was a 24-year-old female who consulted our hospital, complaining of protrusion of her upper anterior teeth and jaw discomfort. During the first visit, examination of the frontal face revealed mandibular deviation to the left side, and intraoral findings revealed Angle Class II maxillary protrusion with functional crossbite at the left molar section. TMJ examination showed bilateral tenderness and TMJ clicking on the right side. Tooth Contacting Habit (TCH) was recognized from the questionnaire on TMJ conditions. MRI examination showed bilateral anterior and lateral disc displacement without reduction on the left side and with reduction on the right side, and erosion was observed at the right condylar head. The patient was diagnosed as having maxillary protrusion with functional mandibular deviation to the left side, and temporomandibular joint disc derangement (type III) and osteoarthrosis of the temporomandibular joint (type IV). Primary TMD management was applied for TCH before orthodontic treatment. After confirming the stability of TMD symptoms, orthodontic treatment was started with four premolar extractions to improve maxillary protrusion with functional mandibular deviation. After the treatment, the Angle Class II molar relationship and severe maxillary protrusion with functional mandibular deviation to the left side were improved, and a good profile and occlusion with anterior guidance were achieved. The distance of mouth opening was increased and bilateral tenderness was improved. MRI examination showed marginal proliferation at the left condylar head. No improvement was noted in TMJ clicking on the right side. The patient is currently in the retention period, and TMD symptoms have not been observed at one year after orthodontic treatment.