Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
A Novel TMJ Replacement Prosthesis for Pets
Join us as we uncover the incredible work of Dr. Boaz Arzi on a groundbreaking temporomandibular joint (TMJ) replacement prosthesis for pets. Discover the urgent need for this innovation due to severe trauma and arthritis in dogs and cats and learn how Boaz's research with cadaver specimens demonstrates the feasibility and superior strength of the prosthesis compared to the natural joint. Boaz's extensive background in TMJ disorders and translational medicine from human applications provides a rich context for understanding the significance of this study.
But that's not all—listen as we delve into the surprising role of the muscle of mastication in jaw stabilization uncovered through kinematic studies and load-to-failure tests. We also explore the potential for AI in customizing joint replacements and discuss upcoming fatigue testing that will pave the way for clinical trials. Boaz shares insights into the broader clinical applications for veterinarians and clients, and even teases the possibility of similar treatments for horses. This episode promises to keep you on the cutting edge of TMJ research in veterinary medicine.
Open access AJVR article: https://doi.org/10.2460/ajvr.24.01.0009
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Speaker 2:You're listening to Veterinary Vertex, a podcast of the APMA Journals. In this episode we chat about the kinematic performance of a novel temporomandibular joint replacement prosthesis under bite force conditions in dogs and cats, with our guest Boaz Arzi.
Speaker 3:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have Boaz joining us. Boaz, thank you again for joining us on our podcast.
Speaker 2:Let's dive right in Boaz. Your AJVR article discusses the kinematic performance of a novel temporomandibular joint replacement prosthesis under bite force conditions in dogs and cats. Please share with our listeners the background on this study.
Speaker 4:Excellent. So, first of all, thank you so much for inviting me and with regard to this really exciting project that we've been working on for several years now. It came about because we've been doing TMJ surgeries and specifically amputation of the TMJ, known as gap arthroplasty or extensive chondilectomy, to relieve ankylosis or to remove pieces of the TMJ where there is a severe trauma, so essentially end stage joint. It can also be because of extensive arthritis or septic arthritis that destroyed the joint. So now we're in a position where we don't have a joint and we know how to remove it very well, but we don't have the next phase. Very well, but we don't have the next phase. We did not have anything to move forward with which in people, is total joint replacement, just like we have for the hip and for elbow, for the knee. We did not have one in dogs and cats or in any veterinary species, unlike in people. So the idea was to actually take the translation backward, to bring translation from the human experience and to improve the quality of life of those patients.
Speaker 2:Thank you so much. We really appreciate you contributing this article to AJVR. So what were some of the pivotal findings from this study?
Speaker 4:So there are several important findings. The primary one, that it can be done, is that it can be done at that stage on cadaver specimens. But the idea that it can be done and we can replace the joint is novel. And the second one was that in the study we used specimens, that we removed all the muscle of mastication and so we learned very quickly that the TM joint, the temporal mandibular joint, without the muscle of mastication is not a very strong joint. It's a hinge-like joint in the cat and in the dog, but if you take away all the muscles it's not really strong. So that was number one, that was actually number two. Number three is that total joint replacement was as strong, if not stronger, in various kinematics aspects as compared to the native joint, which was very exciting to learn.
Speaker 2:So last time that you were on the podcast Boaz, we were talking about the oral maxillofacial region and regenerative medicine. So now we're talking about the TMJ. So what sparked your research interest in TMJ prosthesis?
Speaker 4:So the temporal mandibular joint has been the focus of my research since I've done my fellowship in biomedical engineering, which is where I learned a lot about the TMJ, primarily as it pertains to people and the research and the rigor of research that needs to be done. I've been involved in TMJ research for over a decade now. That's what sparked my idea to go in this direction and so, taking what we have done so far, what we've done before, characterizing the TMJ disorders and finding solutions to these disorders, it's what was driving force behind it.
Speaker 3:Yeah, as Sarah said and you just mentioned, you're really driving the needle forward in TMJ in humans and translational to animals and in the reverse order, and we're super happy to have these manuscripts. So I'm just selfishly curious why did you choose to submit this manuscript to AJVR?
Speaker 4:So AJVR has been the place for us to go for all of our biomechanics studies, and so, as you know, we've published anywhere from fracture stabilization with internal fixation to movements, to kinematics of reconstruction in dogs, and that is the natural progress of this biomechanics and kinematics research of ours. That's why we place all of these in AJBR.
Speaker 3:Well, thank you, we're very happy to have them. You spoke a little bit earlier. Sarah asked you what were some of the pivotal findings of the manuscript. But we're always amazed and like there's more manuscripts coming because there's something that surprised you. What surprised you in this study?
Speaker 4:You know, what surprised me in this study specifically is it's really I'm going back to this is that the role of muscle of mastication is pretending to stabilize the lower jaw, the mandibles. The joint is there and it does work. It allows opening and closing the mouth, but it's really the muscle of mastication that keeps everything together and once you remove it, the joint is not really strong, it's not stable, let's put it this way and that the TMJ replacement device that basically solidified it and put it back in place and was very reliably strong throughout this kinematic study.
Speaker 3:I guess maybe that simplicity or that the muscle doesn't contribute as much as you might think, maybe that makes it folly, makes it ripe for a replacement. Would that be true?
Speaker 4:It will be true, you know, when we place this device on our before we go to the clinics obviously we haven't done those in clinical cases yet. The kinematic study was the pivotal one. Before we do that, we do trust the muscle of mastication to keep it in place and make sure it's not, you know, dislocated and stuff, just like you would from a normal joint.
Speaker 3:Yeah, very nice, I think you just answered the question. What are the next steps for research in TMJ, kinematics and biomechanics, or even clinics?
Speaker 4:So stay tuned. Another paper will be submitted soon. We have three aims for the study before it goes to clinics. The first one was kinematics. The second one, which we've just completed and we're writing it up, is load to failure. So basically, to see what's the maximum load that take this apart, and during the summer, throughout the late summer and early winter, we are studying the fatigue of the device, essentially opening and closing the mouth for several hundreds of thousands of cycles and see if and when it fails, and then I think we'll be ready for starting the clinical trials.
Speaker 2:Well, we look forward to seeing your next submission. So AI is a very heavily talked about topic, and especially in the field of veterinary medicine. So do you see a role for AI in this area of research?
Speaker 4:Absolutely so. You know dogs, cats, specifically dogs. They have several skull conformations and so, looking at this, if you can involve AI in looking at the CT and understanding what type of joint replacement and conformation of the joint replacement will match this, that will be a big deal. We have the doligocephalic, vascular, cephalic and mesocephalic skull conformation, which is unlike in people. When you have a joint, it's going to be similar between most people, but you cannot say this about the. You know the beagle versus the pit bull versus the chihuahua. So we probably need to use AI in this aspect as well.
Speaker 2:Yeah, it's super interesting. I love hearing everyone's answer to that one, because there's so many things that I didn't even think about that AI could be possible to use, so pretty cool. And for those of you just joining us, we're discussing the kinematic performance of a novel temporomandibular joint replacement prosthesis under bite force conditions in dogs and cats with our guest, boaz Arzi. So, boaz, how did your advanced training prepare you to write this manuscript?
Speaker 4:training prepare you to write this manuscript. So I've been trained both in. I did my residency at UC Davis in dentistry and oral surgery and then I did fellowship in biomedical engineering, specifically working on the temporal mandibular joint. So my training prepared me not only to conduct the research and, you know, to see the direction that it needs to move at, but it also helped me in a focusing or finding the angle to bring this biomedical engineering study into clinical perspective, into clinical aspects, and that is, I think, the biggest deal is to take this technology and see how this is clinically applicable.
Speaker 2:I also want to give a shout out to the AJVR journal covers that I see behind you. I think I brought them up last time too, but I love that those are framed they are framed.
Speaker 4:All of the covers are framed behind me.
Speaker 2:That's awesome. So this next set of questions are really important for our listeners, and the first one is going to be from the veterinarian's perspective. So what is one piece of information the veterinarian should know before discussing TMJ prosthesis with the client? Should?
Speaker 4:know before discussing TMJ prosthesis with a client. The one thing is that it's coming it's already available here in research setting and that it's coming and that there will be a solution to loss of TM joint in the near future.
Speaker 2:Very cool. We actually have a new manuscript category called technical tutorial videos, where they teach clinical techniques and they're peer reviewed. So we're trying to have a good peer reviewed resource for our clinicians. So if you ever want to submit a video on how they work, they could also be used potentially as client educational material too. You let us know.
Speaker 4:OK.
Speaker 2:So then, the other side of the relationship. What's one thing clients should consider around TMJ prosthesis?
Speaker 4:The answer will be very similar that it is available in research setting and that those solution to the loss of the joint is in the near future and it's coming and we have good people working on it.
Speaker 3:Boaz, is it coming in horses too? Tmj is a pretty big problem in horses.
Speaker 4:Yes, I know, you know it moves differently. It will probably be similar more to the human one than to the dogs and cats one, because the horse have the side-to-side movement and so forth. But my guess is that, yes, it should come.
Speaker 3:That would be fabulous. Thank you again, and as we wind down, we like to ask a slightly more personal question. So we would like to know what is the oldest or the most interesting item on your desk or in your desk drawer.
Speaker 4:I'm glad you asked this because it's a letter I got from my grandmother when I got my faculty position many years ago, and she sent me a note, an email, congratulating me. It was one sentence. It's actually here next to me and it's a good day because if she would be live, she would be 103 today.
Speaker 2:That's amazing. It's super cool, fantastic story. Yeah, those personal moments definitely do matter. So thank you for sharing that with us, boaz, and thank you, too, for sharing your manuscript with AJVR. We look forward to seeing what else is on the horizon for you.
Speaker 4:Thank you very much and thank you for highlighting it. I really much appreciate it.
Speaker 2:To our listeners. You can read Boaz's article online and AJVR using your favorite search engine. I'm Sarah Wright with Lisa Fortier. We want to thank each of you for joining us on this episode of the Veterinary Vertex podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
