Gap Arthroplasty versus Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A Meta-Analysis

<div><p>Gap arthroplasty (GA) and interpositional arthroplasty (IA) are widely used for the treatment of temporomandibular joint ankylosis (TMJA). However, controversy remains as to whether IA is superior to GA. PubMed, EMBASE, the Cochrane Library, the Web of science and the China National Knowledge Infrastructure were searched for literature regarding these procedures (published from 1946 to July 28, 2014). A study was included in this analysis if it was: (1) a randomized controlled trial or non-randomized observational cohort study; (2) comparing the clinical outcomes between GA and IA with respect to the maximal incisal opening (MIO) and reankylosis; (3) with a follow-up period of at least 12 months. The methodological quality of the included studies was evaluated according to the Newcastle-Ottawa Scale Eight non-randomized observational cohort studies with 272 patients were included. All the statistical analyses were performed using the RevMan 5.3 and Stat 12. The pooled analysis showed no significant difference in the incidence of reankylosis between the IA group (13/120) and the GA group (29/163) (RR= 0.67, 95% CI=0.38 to 1.16; Z=1.43, p=0.15). The IA group showed a significantly larger MIO than the GA group (MD=1.96, 95% CI=0.21 to 3.72, Z=2.19, p=0.03, I²=0%). In conclusion, patients with TMJA could benefit more from IA than GA, with a larger MIO and a similar incidence of reankylosis. IA shows to be an adequate option in the treatment of TMJA based on the results of maximal incisal opening.</p></div

Flow diagram of the study selection.

<p>Flow diagram of the study selection.</p

Funnel plot of the occurrences of reankylosis in GA and IA (TMF) groups, Egger’s test results: t = 0.91, p = 0.458.

<p>Funnel plot of the occurrences of reankylosis in GA and IA (TMF) groups, Egger’s test results: t = 0.91, p = 0.458.</p

Funnel plot of the MIO of GA and IA groups, Egger’s test results: t = -0.48, p = 0.666.

<p>Funnel plot of the MIO of GA and IA groups, Egger’s test results: t = -0.48, p = 0.666.</p

Forest plot of the MIO (GA vs. IA).

<p>Forest plot of the MIO (GA vs. IA).</p

The characteristics of the studies included in the meta-analysis.

<p>Ms: months; Yrs: years; mm: millimeter</p><p>The characteristics of the studies included in the meta-analysis.</p

Forest plot of the occurrences of reankylosis—GA vs. IA (TMF).

<p>Forest plot of the occurrences of reankylosis—GA vs. IA (TMF).</p

Funnel plot of the occurrences of reankylosis in the GA and IA groups, Egger’s test results: t = -0.12, p = 0.912.

<p>Funnel plot of the occurrences of reankylosis in the GA and IA groups, Egger’s test results: t = -0.12, p = 0.912.</p

Isolation and identification of ADSCs.

<p>(<b>A</b>) Representative images of colonies formed by ADSCs at low seeding density after 2 weeks in culture. (<b>B</b>). Flow cytometry analysis of the expression of cell surface markers related to mesenchymal (CD31, CD90, CD105, CD146 and STRO-1) or hematopoietic stem cells (CD34 and CD45). Cont: isotype control. (<b>C</b>) After ADSCs were cultured under osteogenic inductive conditions for 21 days, mineralized nodules were detected following alizarin red staining. ADSCs formed lipid clusters that stained positive for Oil Red O after 21 days of adipogenic induction. Scale bars represent 100 µm.</p

Effect of the PI3K inhibitor LY294002 on expression of eNOS in osteoblasts.

<p><b>A</b>, Expression of PI3K P85 was measured by Western blotting in rat osteoblasts cultured with 5.5 mM or 16.5 mM glucose for 24 h and then changed to basic medium containing 10 µM LY294002 for 120 min. β-Actin was used as the control for equal loading. <b>B</b>, LY294002 inhibited glimepiride-induced phosphorylation of Akt and eNOS in osteoblasts cultured with 5.5 mM glucose. <b>C</b>, LY294002 inhibited glimepiride-induced phosphorylation of Akt and eNOS in osteoblasts cultured with 16.5 mM glucose. <b>D</b>, Immunostaining of P-eNOS in rat osteoblasts cultured with 5.5 mM or 16.5 mM glucose for 24 h and then changed to basic medium containing 10 µM LY294002 for 120 min.</p