ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS 1

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Condylar cartilage (7M)

CONTENTS/SYNOPSIS

Introduction
Types of Cartilage and their Distribution
1.Hyaline cartilage
2.Elastic cartilage
3.Fibrocartilage
Features of Primary and Secondary Cartilage
Condylar cartilage
Differences between condylar and epiphyseal cartilages
Classification of condylar cartilage cell layers
1.Fibrous layer
2.Proliferative cell
3.Hyaline cartilage zone
4.Endochondral ossification zone
Clinical significance of condylar cartilage in orthodontics
References

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INTRODUCTION
Cartilage
• Cartilage is a solid connective tissue that is to a certain extent pliable, making it
resilient.
• These characteristics of cartilage are due to the nature of its matrix. The ground
substance of cartilage is rich in proteoglycans consisting of a core protein with
numerous about 100-glycosaminoglycans (GAGs) attached in bottle-brush
fashion around it.
• The proteoglycans themselves are attached, by special linker proteins to long,
rigid molecules of hyaluronic acid (HA).
• HA itself is a GAG, but is composed of several thousand disaccharide units,
rather than several hundred or less, as are other GAGs. About eighty
proteoglycans are attached to one molecule of HA.
• The matrix also has collagen fibers, but these are of a finer nature (collagen Type
II vs. collagen Type I) than the collagen fibers in most other connective tissues.

TYPES OF CARTILAGE AND THEIR DISTRIBUTION

• There are three kinds of cartilage,
1. Hyaline cartilage
2. Elastic cartilage
3. Fibrocartilage

1. Hyaline cartilage
• Hyaline cartilage is the most abundant type of cartilage.
• Most of the skeleton of the fetus is laid down in cartilage before being replaced
by bone.
• Hyaline cartilage in the adult is found in
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▪ Nose,
▪ Parts of the respiratory tract
▪ At the ends of ribs and
▪ At the articular surfaces of bones of the external auditory canal, the
Eustachian tube, the epiglottis, and the larynx.

2. Elastic cartilage
• Elastic cartilage is found in the external ear, the walls of the external auditory
canal, Eustachian tube, epiglottis, and larynx

3. Fibrocartilage
• Fibrocartilage has characteristics intermediate between those of hyaline cartilage
and dense connective tissue.
• Its presence indicates the need for resistance to compression and shear forces.
• The amount of cartilage in fibrocartilage is variable, it generally occupies a
smaller amount of the tissue and there is no perichondrium.
• It is found in the
▪ Intervertebral disks
▪ Symphysis
▪ Pubis
▪ Articular discs of the sternoclavicular and temporomandibular joints
▪ Menisci of the knee joint and some places where ligaments or tendons attach
to bones
▪ Walls of Trachea and large

PRIMARY CARTILAGE
• They are derivatives of primordial cartilage.
• In primary cartilage, chondroblasts divide and synthesize intercellular matrix.
• The dividing chondroblasts are surrounded by cartilaginous matrix.
• Cells arranged in columnar fashion
• Since surrounded by cartilaginous matrix, primary cartilage is not influenced by
local environmental factors, e.g. Epiphyseal cartilages, synchondroses
• Growth is interstitial. Hence 3-dimensional growth
• Considered to be a genetic pacemaker for growth.

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SECONDARY CARTILAGE
• Secondary cartilage forms on a membranous bone
• No intercellular matrix
• Not surrounded by cartilaginous matrix
• Cells are arranged in haphazard manner
• Affected by external influences which will stimulate growth of cartilage, e.g.
condylar cartilage
• Only peripheral growth takes place
• Contributes only to regional adaptive growth.

CONDYLAR CARTILAGE
• The condylar cartilage is a secondary type of cartilage which was transformed
phylogenetically from the periosteum
• This cartilage is a latecomer, a secondary cartilage, and not a part of the
Meckel's cartilage that acts as the model for the early development of the
mandible.
•
Differences between Condylar and Epiphyseal cartilages
Biologic
Epiphyseal growth plates Condyle
criteria
Origin Derivative of primordial Secondary cartilage formation
cartilage on original membrane bone
Growth Interstitial Peripheral in Fibrocartilage
covering; proliferating cells are
not cartilage cells but
undifferentiated mesenchymal
cells.
Mechanical Unresponsive Responsive
Stimuli
Maturation Secondary ossification centers, Conversion from hypertrophic
final fusion and disappearance to non hypertrophic state but
of all cartilage not complete conversion to
bone

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Histology Only the degenerative zone is Whole hypertrophic area is in

mineralizing state of mineralization,
structural organization is
lacking
Hormonal Marked response to thyroxine Minimal response to thyroxine
control deficiency, after final fusion no deficiency. Mature condyle can
further response to growth be reawakened by growth
hormone hormone

Classification of condylar cartilage cell layers

• Cell layer classification depends on animal species and growth stage, histological
method, and molecular markers used in this
• A classification comprising four cell layers is used to explain the characteristics of
each cell layer because four cell layers can be easily distinguished from each
other based on type I and II collagen localization.

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1. Fibrous layer
• The most superficial layer of the condylar cartilage consists of dense fibrous
connective tissue with scattered cells, and its periphery is continuous with the
outer layer of the periosteum
• The cells are flat and surrounded by dense collagen bundles [38—40].
• This layer is not related to deeper chondrogenic differentiation, but functions
as a protective covering for the underlying cartilaginous tissue.
• Recently, Ohno et al. revealed that superficial zone protein, also known as
proteoglycan-4 and lubricant, is restricted to the superficial part of the condylar
cartilage and functions as a joint boundary lubricant.

2. Proliferative cell
• This layer is based on cellular morphology, this layer is further divided into two
sublayers:
i. The upper sublayer (i.e., polymorphic cell layer), where irregular polygonal
cells with large round nuclei are densely packed; and
ii. The lower sublayer (i.e., flattened cell layer), where flattened cells are
oriented with their long axes parallel to the articular surface
• One unique characteristic of the condylar cartilage is that the cells in the
proliferative layer have multilineage potential and can differentiate into
osteoblasts or chondrocytes (osteochondral progenitors), and more
differentiated cells committed to becoming chondrocytes (chondroprogenitors)
or fat progenitor cells.

3. Hyaline cartilage zone

• The hyaline cartilage zone with randomly distributed chondroblasts and
hypertrophied cells. The matrix of these cells is more towards the condyle

4. Endochondral ossification zone

• The endochondral ossification zone in which the cartilage is resorbed and
replaced with trabecular bone.

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CLINICAL SIGNIFICANCE OF CONDYLAR CARTILAGE IN ORTHODONTICS

1. As per article-The mandibular complex*-Kalevi Koski Turku, Finland
(Transaction of the European Orthodontic Society 1974
• Condylar cartilage cells are apparently multipotential, as are similar cells
elsewhere. Specifically, they can become either chondro genic or osteogenic,
depending on environmental stimuli (Meikle, 1973). This makes it understandable
why condylar cartilage transplants behave as they do.
• On the basis of the existing bulk of evidence ( literature reviews by Meikle, 1973;
Koski, 1975 ), it can be stated that the growth of the condylar cartilage, in terms
of proliferative activity, can be influenced through environmental stimuli of a
mechanical nature, and the same applies to the growth of the bony condyle-
ramus region.
• In regard to the condylar cartilage, this has been attributed to the undifferentiated
nature of the proliferating cells (Charlier et al., 1969, Petrovic and Stutzmann,
1972)

2. As per Review article -Growth of the mandible and biological characteristics

of the mandibular condylar cartilage Itaru Mizoguchi (Japanese Dental
Science Review (2013)
• Role of the condylar cartilage in mandibular growth
▪ In a long bone, two spatially separated cartilages (i.e., articular cartilage and
growth plate) exist during the growth stage.
▪ The articular cartilage functions as a shock absorber against mechanical
loading and the growth plate functions as a growth site.
▪ In contrast, only a single cartilage, the mandibular condylar cartilage, exists in
the mandible throughout life, and plays roles in articulating function and
growth. Therefore, the condylar cartilage is an ‘‘all-in-one type tissue’’.
▪ The disturbance of condylar growth greatly influences maxillofacial
morphology and occlusal relationships.
▪ When the bilateral condyles are affected, → the mandible rotates in the
posteroinferior (clockwise) direction, resulting in an anterior open bite
▪ When a unilateral condyle is affected, → displacement of the mandible to the
affected side, facial asymmetry, and a lateral cross bite are elicited.

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3. Role of condyle in functional orthopaedics

Tentative interpretation of the method of operation of functional appliances

• It is explained by 2 ways-
1. Growth Relativity Hypothesis
▪ The glenoid fossa promotes condylar growth with the use of orthopedic
mandibular advancement therapy.
▪ Initially, that displacement affects the fibrocartilaginous lining in the glenoid
fossa to induce bone formation locally.

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▪ This is followed by the stretch of non-muscular viscoelastic tissues. Third

and the most interesting aspect is the new bone formation some distance
from the actual retrodiscal tissue attachments in the fossa
▪ The glenoid fossa and the displaced condyle are both influenced by the
articular disk, fibrous capsule, and synovium, which are contiguous,
anatomically and functionally, with the viscoelastic tissues.
▪ Therefore, condylar growth is affected by viscoelastic tissue forces via
attachment of the fibrocartilage that blankets the head of the condyle.
▪ Microscopic examination of TMJ sections has revealed direct connective
tissue attachments of the retrodiskal tissues into the unique
fibrocartilaginous layer of the condylar head

2. Light Bulb Analogy of Condylar growth and Retention

▪ The condyle lights up like a LIGHT BULB on a dimmer switch when it is
continuously advanced.
▪ The reactivated muscle activity dims the light bulb and returns it to normal
growth activity at the end of treatment

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REFERENCES
1. Koski K. The mandibular complex. The European Journal of Orthodontics. 2007
Apr 1;29(suppl_1):i118-23.
2. Mizoguchi I, Toriya N, Nakao Y. Growth of the mandible and biological
characteristics of the mandibular condylar cartilage. Japanese Dental Science
Review. 2013 Nov 1;49(4):139-50.
3. Premkumar S. Textbook of craniofacial growth. JP Medical Ltd; 2011.
4. Proffit WR, Fields WH. A textbook of contemporary orthodontics.
5. Kharbanda OP. Orthodontics: Diagnosis of & Management of Malocclusion &
Dentofacial Deformities-E Book. Elsevier Health Sciences; 2019 Dec 4.
6. Mizoguchi I, Toriya N, Nakao Y. Growth of the mandible and biological
characteristics of the mandibular condylar cartilage. Japanese Dental Science
Review. 2013 Nov 1;49(4):139-50.

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