Department of Orthodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.
Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
Clin Oral Investig. 2018 Jan;22(1):57-67. doi: 10.1007/s00784-017-2189-9. Epub 2017 Aug 1.
The purpose of this systematic review was to elucidate how different modalities and intensities of mechanical loading affect the metabolic activity of cells within the fibro-cartilage of the temporomandibular joint (TMJ).
A systematic review was conducted according to PRISMA guidelines using PubMed, Embase, and Web of Science databases. The articles were selected following a priori formulated inclusion criteria (viz., in vivo and in vitro studies, mechanical loading experiments on TMJ, and the response of the TMJ). A total of 254 records were identified. After removal of duplicates, 234 records were screened by assessing eligibility criteria for inclusion. Forty-nine articles were selected for full-text assessment. Of those, 23 were excluded because they presented high risk of bias or were reviews. Twenty-six experimental studies were included in this systematic review: 15 in vivo studies and 11 in vitro ones.
The studies showed that dynamic mechanical loading is an important stimulus for mandibular growth and for the homeostasis of TMJ cartilage. When this loading is applied at a low intensity, it prevents breakdown of inflamed cartilage. Yet, frequent overloading at excessive levels induces accelerated cell death and an increased cartilage degradation.
Knowledge about the way temporomandibular joint (TMJ) fibrocartilage responds to different types and intensities of mechanical loading is important to improve existing treatment protocols of degenerative joint disease of the TMJ, and also to better understand the regenerative pathway of this particular type of cartilage.
本系统评价的目的是阐明不同方式和强度的机械加载如何影响颞下颌关节（TMJ）纤维软骨内细胞的代谢活性。
根据 PRISMA 指南，使用 PubMed、Embase 和 Web of Science 数据库进行系统评价。根据预先制定的纳入标准（即 TMJ 的体内和体外研究、机械加载实验以及 TMJ 的反应）选择文章。共确定了 254 条记录。去除重复项后，通过评估纳入标准的资格筛选出 234 条记录。选择 49 篇全文进行评估。其中 23 篇因高偏倚风险或为综述而被排除。本系统评价共纳入 26 项实验研究：15 项体内研究和 11 项体外研究。
这些研究表明，动态机械加载是下颌生长和 TMJ 软骨稳态的重要刺激因素。当这种加载强度较低时，它可以防止炎症软骨的破坏。然而，频繁过度加载会导致细胞加速死亡和软骨降解增加。
了解 TMJ 纤维软骨对不同类型和强度的机械加载的反应方式对于改善 TMJ 退行性关节疾病的现有治疗方案以及更好地了解这种特殊类型软骨的再生途径非常重要。
