The temporomandibular joint (TMJ) is a site of intense morbidity for millions of people, especially young, pre-menopausal women. Central to TMJ afflictions are the cartilaginous tissues of the TMJ, especially those of the disc and condylar cartilage, which play crucial roles in normal function of this unusual joint. Damage or disease to these tissues significantly impacts a patient's quality of life by making common activities such as talking and eating difficult and painful. Unfortunately, these tissues have limited ability to heal, necessitating the development of treatments for repair or replacement. The burgeoning field of tissue engineering holds promise that replacement tissues can be constructed in the laboratory to recapitulate the functional requirements of native tissues. This book outlines the biomechanical, biochemical, and anatomical characteristics of the disc and condylar cartilage, and also provides a historical perspective of past and current TMJ treatments and previous tissue engineering efforts. This book was written to serve as a reference for researchers seeking to learn about the TMJ, for undergraduate and graduate level courses, and as a compendium of TMJ tissue engineering design criteria. Table of Contents: The Temporomandibular Joint / Fibrocartilage of the TMJ Disc / Cartilage of the Mandibular Condyle / Tissue Engineering of the Disc / Tissue Engineering of the Mandibular Condyle / Current Perspectives
Osteochondral defects can be challenging to treat, first, because the damaged articular cartilage has a poor intrinsic reparative capability, and second, because these defects cause chronic pain and serious disability. That is why cartilage repair remains one of the most challenging issues of musculoskeletal medicine. Arthroscopic and open techniques that have been developed over the last two decades intend to promote the success of complete repair of the articular cartilage defects; nevertheless, these therapies cannot always offer 100% success. Nowadays, cartilage tissue engineering is an emerging technique for the regeneration of cartilage tissue. Taking into consideration these perspectives, this book aims to present a summary of cartilage tissue engineering, including development, recent progress, and major steps taken toward the regeneration of functional cartilage tissue. Special emphasis is placed on the role of stimulating factors, including growth factors, gene therapies, as well as scaffolds, including natural, synthetic, and nanostructured.
Tissue engineering takes advantages of the combined use of cultured living cells and three-dimensional scaffolds to reconstruct adult tissues that are absent or malfunctioning. This book brings together scientists and clinicians working on a variety of approaches for regenerating of damaged or lost cartilage and bone to assess the progress of this dynamic field. In its early days, tissue engineering was driven by material scientists who designed novel bio-resorbable scaffolds on which to seed cells and grow tissues. This ground-breaking work generated high expectations, but there have been significant stumbling blocks holding back the widespread use of these techniques in the clinic. These challenges, and potential ways of overcoming them, are given thorough coverage in the discussions that follow each chapter. The key questions addressed in this book include the following. How good must cartilage repair be for it to be worthwhile? What is the best source of cells for tissue engineering of both bone and cartilage? Which are the most effective cell scaffolds? What are the best preclinical models for these technologies? And when it comes to clinical trials, what sort of outcome measures should be used? With contributions from some of the leading experts in this field, this timely publication will prove essential reading for anyone with an interest in the field of tissue engineering.
Cartilage injuries in children and adolescents are increasingly observed, with roughly 20% of knee injuries in adolescents requiring surgery. In the US alone, costs of osteoarthritis (OA) are in excess of $65 billion per year (both medical costs and lost wages). Comorbidities are common with OA and are also costly to manage. Articular cartilage's low friction and high capacity to bear load makes it critical in the movement of one bone against another, and its lack of a sustained natural healing response has necessitated a plethora of therapies. Tissue engineering is an emerging technology at the threshold of translation to clinical use. Replacement cartilage can be constructed in the laboratory to recapitulate the functional requirements of native tissues. This book outlines the biomechanical and biochemical characteristics of articular cartilage in both normal and pathological states, through development and aging. It also provides a historical perspective of past and current cartilage treatments and previous tissue engineering efforts. Methods and standards for evaluating the function of engineered tissues are discussed, and current cartilage products are presented with an analysis on the United States Food and Drug Administration regulatory pathways that products must follow to market. This book was written to serve as a reference for researchers seeking to learn about articular cartilage, for undergraduate and graduate level courses, and as a compendium of articular cartilage tissue engineering design criteria. Table of Contents: Hyaline Articular Cartilage / Cartilage Aging and Pathology / In Vitro / Bioreactors / Future Directions
The temporomandibular joint (TMJ) is a site of intense morbidity for millions of people, especially young, pre-menopausal women. Central to TMJ afflictions are the cartilaginous tissues of the TMJ, especially those of the disc and condylar cartilage, which play crucial roles in normal function of this unusual joint. Damage or disease to these tissues significantly impacts a patient's quality of life by making common activities such as talking and eating difficult and painful. Unfortunately, these tissues have limited ability to heal, necessitating the development of treatments for repair or replacement. The burgeoning field of tissue engineering holds promise that replacement tissues can be constructed in the laboratory to recapitulate the functional requirements of native tissues. This book outlines the biomechanical, biochemical, and anatomical characteristics of the disc and condylar cartilage, and also provides a historical perspective of past and current TMJ treatments and previous tissue engineering efforts. This book was written to serve as a reference for researchers seeking to learn about the TMJ, for undergraduate and graduate level courses, and as a compendium of TMJ tissue engineering design criteria. Table of Contents: The Temporomandibular Joint / Fibrocartilage of the TMJ Disc / Cartilage of the Mandibular Condyle / Tissue Engineering of the Disc / Tissue Engineering of the Mandibular Condyle / Current Perspectives
Articular cartilage degeneration, due to injury and osteoarthritis, is an irreversible disease condition with existing treatment options. Damaged cartilage in the patellofemoral and temporomandibular joints are met with unsatisfactory treatment options that often fail to halt the disease progression. Tissue engineering aims to solve this unmet need by engineering a functional replacement tissue as well as by promoting a healthy regenerative environment within the damaged joint. A key component in engineering neocartilage with such properties is the cell source. Costal chondrocytes of the rib cage have recently been recognized for their ability to form robust cartilage implants. However, clinical translation of this cell source is still hindered because mechanical properties of the engineered implants need to be improved, and treatment with the engineered implant needs to be demonstrated in an appropriate preclinical model. Toward translating tissue engineering technologies to clinical applications, the global objectives of this research are: 1) to engineer biomimetic cartilage implants from costal chondrocytes, through the development of mechanical stimulation techniques, and 2) to evaluate the safety and efficacy of engineered cartilage implants orthotopically in a relevant large animal model. To address these objectives, this research 1) confirmed costal chondrocytes, of non-articular cartilage origin, to be appropriate for use in articular joints, 2) designed and developed compressive stimulation regimens that improved the compressive properties of neocartilage, 3) designed and developed tensile stimulation regimens that enhanced the tensile properties and anisotropy of neocartilage, and 4) investigated the safety and efficacy of neocartilage in healing an orthotopic defect in a minipig model. Costal chondrocytes were confirmed to be suitable for articular cartilage tissue engineering. Costal cartilage is densely populated with chondrocytes, rendering a good donor source of cells. Neocartilage derived from passaged costal chondrocytes, through the self-assembling process, were cohesive and robust. When compared to the native articular cartilage of the patellofemoral joint for their potential as a replacement tissue, the implants exhibited 45% of native cartilage salient properties. These results indicated that costal chondrocytes are suitable for articular cartilage tissue engineering, with the potential for further improvement with mechanical stimulation. Neocartilage derived from costal chondrocytes was shown for the first time to respond to mechanical stimulation, in particular, the passive axial compressive stimulation. During the self-assembling process, neocartilage in the matrix synthesis phase and maturation phase are amenable to passive axial compression, providing flexibly in the timing of the stimulation. When compressive magnitude was examined, 3.3 kPa and 5 kPa were found efficacious in improving neocartilage compressive properties. Stimulation with a higher magnitude was found ineffective. Neocartilage tensile properties were improved through the application of a bioactive regimen (TGF-[beta]1, chondroitinase ABC, and lysyl oxidase like 2). This work demonstrated that mechanical and bioactive stimuli are both critical in creating mechanically robust neocartilage from costal chondrocytes. Further improvements in tensile properties were achieved with tensile stimulation. A beneficial tensile stimulation regimen has not been achieved in prior studies; this work showed for the first time that tensile stimulation, especially continuous tensile stimulation, was highly effective in creating neocartilage with native tissue-like tensile properties. Anisotropy was also achieved with this stimulation. Therefore, this research contributed significantly toward overcoming two of the major challenges posed by cartilage tissue engineering. The examination of this regimen in a human chondrocyte-derived neocartilage also showed that tensile stimulation was beneficial toward neocartilage development and mechanical robustness, demonstrating the translation potential of this stimulation regimen. Finally, robust neocartilage implants, derived from costal chondrocytes and improved through mechanical and bioactive stimuli, showed safety and efficacy when examined orthotopically in a large animal model. A novel surgical technique, called the intra-laminar fenestrated technique, was successfully developed and implemented to model TMJ disc thinning in vivo. Neocartilage implants, of allogeneic origin, did not provoke any adverse immunological response from the host. They were effective in promoting repair tissue formation in the defect and integration between implant and native tissue, resulting in closing and healing of the defect. Overall, this research made strides in bringing tissue engineered neocartilage implants from a clinically relevant cell source toward a translational pathway. The successful engineering of implants and demonstrated treatment of an orthotopic defect established the foundational work for future preclinical studies. With further research, scaffold-free tissue engineered implants could significantly widen clinical treatment options for patients suffering from patellofemoral and temporomandibular joint degeneration.
Temporomandibular disorders (TMDs), are a set of more than 30 health disorders associated with both the temporomandibular joints and the muscles and tissues of the jaw. TMDs have a range of causes and often co-occur with a number of overlapping medical conditions, including headaches, fibromyalgia, back pain and irritable bowel syndrome. TMDs can be transient or long-lasting and may be associated with problems that range from an occasional click of the jaw to severe chronic pain involving the entire orofacial region. Everyday activities, including eating and talking, are often difficult for people with TMDs, and many of them suffer with severe chronic pain due to this condition. Common social activities that most people take for granted, such as smiling, laughing, and kissing, can become unbearable. This dysfunction and pain, and its associated suffering, take a terrible toll on affected individuals, their families, and their friends. Individuals with TMDs often feel stigmatized and invalidated in their experiences by their family, friends, and, often, the health care community. Misjudgments and a failure to understand the nature and depths of TMDs can have severe consequences - more pain and more suffering - for individuals, their families and our society. Temporomandibular Disorders: Priorities for Research and Care calls on a number of stakeholders - across medicine, dentistry, and other fields - to improve the health and well-being of individuals with a TMD. This report addresses the current state of knowledge regarding TMD research, education and training, safety and efficacy of clinical treatments of TMDs, and burden and costs associated with TMDs. The recommendations of Temporomandibular Disorders focus on the actions that many organizations and agencies should take to improve TMD research and care and improve the overall health and well-being of individuals with a TMD.
This detailed book brings together a collection of methodologies, from the most basic to the more complex, that provides researchers with a platform they can use to embark on a cartilage research career. To aid in the search for novel therapies for cartilage regeneration, this volume addresses 3D cartilage models, challenges associated with RNA and protein extraction, imaging, gene transfer, as well as stable differentiation and variations in cell phenotype from different tissue origins. Written for the highly successful Methods in Molecular Biology series, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step and readily reproducible laboratory protocols, and tips on troubleshooting and avoiding known pitfalls. Authoritative and up-to-date, Cartilage Tissue Engineering serves as an ideal guide for researchers working to advance the vital study of cartilage biology and repair.
Bone and Cartilage Engineering provides a complete overview of recent knowledge in bone and cartilage tissue engineering. It follows a logical approach to the various aspects of extracorporal bone and cartilage tissue engineering. The cooperation between a basic scientist and a clinician made it possible to structure the book's content and style according to the interdisciplinary character of the field. The comprehensive nature of the book, including detailed descriptions of laboratory procedures, preclinical approaches, clinical applications, and regulatory issues, will make it an invaluable basis for everyone working in this field. This book will serve as a fundamental tool for basic researchers to establish or refine tissue engineering techniques as well as for clinicians to understand and use this modern therapeutic option.
In this issue of Atlas of the Oral and Maxillofacial Surgery Clinics, guest editor Dr. Florencio Monje Gil brings his considerable expertise to the topic of Temporomandibular Joint Surgery. TMJ disorders affect 12% or more of the population in the U.S. alone, primarily women in their childbearing years. In this issue, top experts in the field provide comprehensive, current tutorials of every major TMJ surgery, including articles on pre- and postoperative treatment. - Contains 14 practice-oriented topics including rules for surgical decision making in temporomandibular joint treatment; temporomandibular joint arthrocentesis; operative arthroscopy and electrocoagulation of the temporomandibular joint; open temporomandibular joint surgery: discectomy with or without interpositional reconstruction; temporomandibular joint surgery: open discopexy; and more. - Provides in-depth clinical reviews on temporomandibular joint surgery, offering actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
