Clemson University TigerPrints All Dissertations Dissertations 5-2018 Behavioral, Functional, and Shape Assessment for Temporomandibular Joint Feng Wei Clemson University, [email protected] Follow this and additional works at: https://tigerprints.clemson.edu/all_dissertations Recommended Citation Wei, Feng, "Behavioral, Functional, and Shape Assessment for Temporomandibular Joint" (2018). All Dissertations. 2097. https://tigerprints.clemson.edu/all_dissertations/2097 This Dissertation is brought to you for free and open access by the Dissertations at TigerPrints. It has been accepted for inclusion in All Dissertations by an authorized administrator of TigerPrints. For more information, please contact [email protected]. BEHAVIORAL, FUNCTIONAL, AND SHAPE ASSESSMENT FOR TEMPOROMANDIBULAR JOINT A Dissertation Presented to the Graduate School of Clemson University In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Bioengineering by Feng Wei May 2018 Accepted by: Hai Yao, PhD, Committee Chair Mark Van Horn, PhD Tong Ye, PhD Martine LaBerge, PhD ABSTRACT Temporomandibular joint (TMJ) disorders affect over 10 million people in the US with an annual economic cost of more than $4 billion. Due to intriguing etiological factors of TMJ disorders, objective and accurate diagnosis is difficult and so is with the treatment. Consequently, there is the high recurrence rate. To make the situation even worse, many other types of diseases, including cancer, share symptoms and signs with TMJ disorders. Early non-invasive, objective, subject-specific and accurate diagnosis is vital because incorrect or delayed diagnosis can cause patients to miss optimal treatment times, increase unnecessary therapy expenses and even endanger patients’ lives. The gold standard diagnostic criteria for TMJ disorders (DC/TMD) largely depend on subjective decisions, and therefore, it is necessary to develop a patient specific, non-invasive, and quantitative assessment system, to identify possible risk indicators for the objective early diagnosis of TMJ disorders and to determine their etiological biomechanical mechanisms by investigating the underlying biomechanical and transport pathophysiology of these indicators. As a result, significant advances in biomechanics and nutrient supply research are essential for early diagnosis and management. Common symptoms of joint sounds, limited or asymmetrical jaw movement, teeth misalignment, pain in the muscle, jaw or neck and jaw muscle stiffness indicate that an objective TMJ disorders diagnosis is necessary and should include TMJ muscle, motion and morphology assessment. Also, compared to other well-developed joint systems such as knee, glenohumeral and hip joints, TMJ has received less attention in biomechanics research because of the joint’s complexity in anatomy, neuromuscular recruitment and motion. The direct in vivo experimental ii measurement for articular space, contact force, stress distribution and nutrient supply in subject-specific TMJ components is superior to other means when a subject-specific diagnosis result is required. However, the TMJ complex anatomy, together with dense blood vessels and surrounding neuron system impedes the direct in vivo measurement in humans without breaking joint function integrity. The continuous development of advanced high-technologies has facilitated the development of many numerous scientific and objective diagnosis tools. Therefore, the objectives of this research are to: 1) build a non-invasive data collection system of TMJ motion, muscular electromyography and bite force and 2) determine the behavioral, functional, and morphological aspects for objective diagnosis of TMJ disorders and understanding the underlying pathology. Our central hypothesis is that TMJ properties of muscle, motion, and shape in patients are sensitive to TMJ disorders and, therefore, can be adapted to enhancing objective diagnosis criteria, functional rehabilitation assessment, therapeutic monitor and understanding the underlying pathology. Aim 1: Determine the muscle activity pattern by calculating EMG parameters for TMJ muscles of mastication. Aim 2: Determine the feature of TMJ kinematics by collecting TMJ motion tracking data and analyzing TMJ motion. Aim 3: Determine the patient-specific TMJ 3D shape signature. The outcome of this study will yield a data collection system for establishing an objective and subject-specific diagnosis and will build a pathway between biomechanics and the pathophysiology. iii ACKNOWLEDGMENTS I would like to acknowledge the invaluable advice, patience and support of my mentor and committee chair, Dr. Hai Yao. I also would like to acknowledge the other members of my graduate committee, Drs. Mark Van Horn, Tong Ye, and Martine LaBerge for their guidance, suggestions, time and expertise. I would like to thank all the current and past members of the Yao Tissue Biomechanics Laboratory as well as research collaborators for their efforts and guidance. I would also like to thank Thomas Gallien and Maria Torres in the Clemson-MUSC Bioengineering program. I sincerely appreciate their friendship and efforts in establishing such a nice and compatible community. Finally, I would like to thank my family for their generous love, encouragement and support through all my life. iv TABLE OF CONTENTS Page ABSTRACT ............................................................................................................... I ACKNOWLEDGMENTS ........................................................................................ IV TABLE OF CONTENTS ........................................................................................... V LIST OF TABLES ................................................................................................... VII LIST OF FIGURES ................................................................................................ VIII CHAPTER ONE: INTRODUCTION .......................................................................... 1 Objective and Specific Aims .......................................................................................... 1 Organization of Dissertation ........................................................................................... 5 CHAPTER TWO: BACKGROUND AND SIGNIFICANCE ...................................... 7 TMJ and TMJ Disorders ................................................................................................. 7 Clinical Relevance and Impact on Society ..................................................................... 9 Etiology, Diagnosis and Management .......................................................................... 13 TMJ Anatomy and Function ......................................................................................... 19 TMJ Disorders and Behavior ........................................................................................ 53 Mandibular Movement and Functional Assessment ..................................................... 59 Intra-articular Space Analysis and Shape-based Contact Area..................................... 96 TMJ Biomechanics, Tribology, and Transport ........................................................... 105 Proposed Research and Scope of the Project .............................................................. 112 CHAPTER THREE: CASE STUDY OF HUMAN TMJ MASTICATORY MUSCLE – ACTIVITY PATTERN THROUGH ELECTROMYOGRAM STUDY ........................................................ 114 Introduction ................................................................................................................. 114 Materials and Methods ................................................................................................ 116 Results ......................................................................................................................... 123 Discussion ................................................................................................................... 128 CHAPTER FOUR: CASE STUDY OF HUMAN TMJ KINEMATICS - NORMAL OPEN-CLOSE MOVEMENT ..................................... 132 v Table of Contents (Continued) Page Introduction ................................................................................................................. 132 Materials and Methods ................................................................................................ 134 Results ......................................................................................................................... 138 Discussion ................................................................................................................... 147 CHAPTER FIVE: CASE STUDY OF HUMAN TMJ KINEMATICS - A CUSTOMIZED MOTION-EMG- BITEFORCE SIMUTANEOUS DATA COLLECTION SYSTE ............................. 150 Introduction ................................................................................................................. 150 Materials and Methods ................................................................................................ 152 Results ......................................................................................................................... 166 Discussion ................................................................................................................... 173 CHAPTER SIX: CASE STUDY OF HUMAN TMJ CONTACT AREA IN TMJ INTRA-ARTICULAR SPACE ........................................................ 177 Introduction ................................................................................................................