Association of radiographic and clinical findings in patients with temporomandibular joints osseous alteration

Associations of inflammatory polyarthritis with clinical and radiological findings of temporomandibular disorders

OBJECTIVE

To evaluate the association of different forms of inflammatory polyarthritis with clinical signs of temporomandibular disorders (TMD) and radiological findings in temporomandibular joint (TMJ), based on a nationwide health survey in Finland. The aim was also to assess the presence of clinical and radiological TMD findings in subjects with increased risk for developing rheumatoid arthritis (RA).

MATERIAL AND METHODS

Anationally representative sample included 6331 Finnish adults who participated in the Health 2000 Survey (BRIF8901). Subjects were examined for signs of TMD, findings in panoramic radiograph of TMJ, musculoskeletal health and serology (rheumatoid factor, RF, and anti-cyclic citrullinated peptide, aCCP).

RESULTS

Sixty-four percent of seronegative RAand 60% of seropositive RAsubjects had at least one sign of TMD. While adjusting for confounding factors (gender, age, dentures and smoking history), RAwas significantly associated with crepitation and abnormal radiological findings in TMJ. Seronegative RAwas also associated with restricted mouth opening. Systemic autoimmunity associated with RA("at risk of RA") was not associated with clinical or radiological TMD findings.

CONCLUSIONS

Clinical and radiological findings of TMD are more prevalent among subjects with inflammatory polyarthritis than among the population in general in the Finnish adult population.

Temporomandibular involvement in children and adolescents with juvenile idiopathic arthritis: a 2-year prospective cohort study

This study aimed to clinically evaluate temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) and the ability to identify and/or predict development of TMJ-deformities over time using cone beam computed tomography (CBCT). The predictive value of self-reported TMJ pain was also assessed. A prospective longitudinal cohort study comprising 54 children with JIA, 39 girls and 15 boys, was performed. All children had active disease at baseline, 50% with the subtype oligoarthritis. Repeated clinical orofacial and CBCT examinations were performed over a two-year period. At baseline, 39% had radiographic TMJ deformities (24% unilateral, 15% bilateral), at 2-year follow-up, 42% (p > 0.05). Both progressing and improving TMJ deformities were observed. An association was found between TMJ-deformities and self-reported TMJ pain at baseline (p = 0.01). Maximum unassisted mouth opening (MUO) was smaller for children with TMJ-deformities (p < 0.05). The prevalence of palpatory muscle pain was high (48-59%) but not predictive of development of TMJ-deformities. TMJ noises increased over time and crepitations were associated with TMJ-deformities (p < 0.05). In conclusion, in children with JIA, self-reported TMJ pain and dysfunction were common and predictive of TMJ deformities. TMJ deformities were associated with smaller MUO and palpatory TMJ pain as well as crepitations. Trial registration. ClinicalTrials.gov Protocol id: 2010/2089-31/2.

Three-dimensional theoretical model for effectively describing the effect of craniomaxillofacial structural factors on loading situation in the temporomandibular joint

BACKGROUND

Temporomandibular joint (TMJ) overloading is considered a primary cause of temporomandibular joint disorders (TMD). Accordingly, craniomaxillofacial structural parameters affect the loading situation in the TMJ. However, no effective method exists for quantitatively measuring the loading variation in human TMJs. Clinical statistics, which draws from general rules from large amounts of clinical data, cannot entry for exploring the underlying biomechanical mechanism in craniomaxillofacial system. The finite element method (FEM) is an effective tool for analyze the stress and load on TMJs for several cases in a short period of time; however, it is difficult to generalize general patterns through calculations between different cases due to the different geometric characteristics and occlusal contacts between each case.

METHODS

(1) This study included 88 subjects with 176 unilateral data to measure angle (α) of the distance to the plane of occlusion. The bone destruction score was evaluated for clinical statistics. To rule out effects of the potential factors and ensure the generality of the study, one participant with no obvious bone destruction was selected as the standard case for establishing the three-dimensional (3D) theoretical model and FEM. (2) Three groups of forces, including biting, muscles and joint reaction forces on mandible, were adopted to establish a 3D theoretical model. (3) By modifying the sagittal α and coronal three types of deviation angle (φ) of the original model, nine candidate models were obtained for the FEM studies.

RESULTS

(1) The static equilibrium equations, were used to establish a 3D theoretical model for describing the loading of the TMJ. The theoretical model was validated by monotonously modifying the structural parameter in comparison to two-dimensional theoretical models reported previously; (2) The force on the TMJ gradually decreased with α, and this trend was validated by both clinic statistics and FEM results; (3) The effects of the three types of deviation angle were different. The results of the case where only rotating biting forces were considered was consistent with clinical statistics, indicating that the side with lower α experiences higher TMJ load. (4) Changing the unilateral proportionality coefficients of biting and muscle force produced opposite effects, wherein the effects of the muscle force were stronger than those of the biting forces.

CONCLUSIONS

A negative correlation was observed between the joint load and α. Among the three types of asymmetric deformities, occlusal deviations were the primary factors leading to TMD. Unilateral occlusion can result in a greater load on the ipsilateral joint and should be avoided when using the side corresponding to the TMD. This study provides a theoretical basis for the biomechanical mechanism of TMD and also enables the targeted mitigation and treatment of TMD through structural modification.

Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis

OBJECTIVE

To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards.

DESIGN

A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis.

RESULTS

This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties.

CONCLUSIONS

Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.

Assessment of condylar anatomy and degenerative changes in temporomandibular joint disorders - A scoping review

Temporomandibular disorders (TMDs) are a group of conditions that cause pain and dysfunction in the temporomandibular joint (TMJ) and muscles that control mandibular movement. In most cases, the etiology is unclear and is considered multifactorial. Recent research suggests that some forms of TMD could be associated with specific TMJ morphological characteristics. This study aims to provide a review of the reported anatomical and degenerative morphological condylar characteristics of subjects with a clinical diagnosis of TMD as described with the use of CBCT imaging, as well as the detection of potential predisposing anatomical factors. This review was developed and reported in accordance with the PRISMA-ScR Checklist. A comprehensive search was performed in five databases. Reports were screened by two independent reviewers based on preselected inclusion and exclusion criteria. 45 studies were included in this review. The most frequently reported degenerative changes associated with TMD were condylar surface erosion, flattening, osteophytes, and sclerosis. Anatomical characteristics included a small condylar size and a posterior position of the condylar head in the TMJ. The anterosuperior area of the condylar head appears to be the most frequently affected. More studies are required to determine potential specific predisposing anatomical characteristics.

Potential of ultra-high-resolution CT in detecting osseous changes of temporomandibular joint: experiences in temporomandibular disorders

BACKGROUND

Osseous changes of the temporomandibular joint (TMJ) are related to the progression of temporomandibular disorders (TMD), and computed tomography (CT) plays a vital role in disease evaluation.

OBJECTIVE

The aims of this study were to evaluate the image quality and diagnostic value of ultra-high-resolution CT (U-HRCT) in TMD compared to cone-beam CT (CBCT).

METHODS

TMD patients who underwent both CBCT and U-HRCT between November 2021 and September 2022 were retrospectively included. Image quality scores were assigned for four osseous structures (the cortical and trabecular bones of the condyle, articular eminence, and glenoid fossa) by two independent observers from Score 1 (unacceptable) to Score 5 (excellent). Diagnostic classification of TMD was categorized as follows: Class A (no evident lesion), Class B (indeterminate condition) and Class C (definitive lesion). Image quality scores and diagnostic classifications were compared between CBCT and U-HRCT. The Cohen's Kappa test, Wilcoxon signed-rank test, Chi-square test and Fisher's exact test were conducted for statistical analysis.

RESULTS

Thirty TMD patients (median age, 30 years; interquartile range, 26-43 years; 25 females) with 60 TMJs were enrolled. Image quality scores were higher for U-HRCT than for CBCT by both observers (all Ps < 0.001). Definitive diagnoses (Class A and C) were achieved in more cases with U-HRCT than with CBCT (93.3% vs. 65.0%, Fisher's exact value = 7.959, P = 0.012). Among the 21 cases which were ambiguously diagnosed (Class B) by CBCT, definitive diagnosis was achieved for 17 cases (81.0%) using U-HRCT.

CONCLUSIONS

U-HRCT can identify osseous changes in TMD, providing improved image quality and a more definitive diagnosis, which makes it a feasible diagnostic imaging method for TMD.

Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

Exploring the Relationship between Perfectionism and Pain in Patients with Temporomandibular Disorders: A Cross-Sectional Study

Objectives

The purpose of this cross-sectional study was to examine the relationship between perfectionism and pain in patients with temporomandibular disorders (TMDs).

Methods

A total of 345 TMD patients were included. A questionnaire consisting of questions of demographic information, the 15-item short form of the Hewitt and Flett Multidimensional Perfectionism Scale, and the Patient Health Questionnaire-4 (PHQ-4) was distributed. According to the diagnostic criteria for TMDs, patients were categorized as pain-related (PT) and non-pain-related (NPT) groups, whereas PT patients were further divided into patients with pain-related TMDs only (OPT) and patients with combined pain-related and intra-articular TMDs (CPT). Data were analyzed using the chi-square test, Spearman's correlation, and logistic regression analysis with the significance level set at p < 0.05.

Results

There were 68 patients in the NPT group, 80 in the OPT group, and 197 in the CPT group. PT patients had significantly higher perfectionism scores (63.58 ± 13.63) than NPT patients (56.32 ± 12.95, p < 0.001). The PHQ-4 score in the PT group was also higher. After adjusting the PHQ-4 scores, perfectionism scores of the PT group were 6.11 points higher than those in the NPT group (p < 0.001). There were no statistical differences in all parameters of OPT and CPT groups (p > 0.05). Perfectionism in total, other-oriented perfectionism (OOP), and socially prescribed perfectionism (SPP) showed significant but weak correlations with PHQ-4 scores (p < 0.001), while self-oriented perfectionism (SOP) was also significantly but very weakly correlated with PHQ-4 scores (p < 0.05).

Conclusions

Pain-related TMD patients exhibited higher perfectionism scores than NPT patients, and neither their perfectionism nor pain scores were correlated with intra-articular diseases of TMJ. OOP and SOP presented weak correlations with psychological distress in TMD patients. It is suggested that pain-related TMD patients could be screened for perfectionism and perfectionism could be considered when proposing psychological treatment strategies to PT patients.

Cone-beam computed tomographic characteristics in degenerative temporomandibular joint disease patients with chewing side preference

OBJECTIVES

This study is aimed at assessing the Cone-beam computed tomographic (CBCT) characteristics of temporomandibular joints (TMJ) in degenerative temporomandibular joint disease (DJD) patients with chewing side preference (CSP).

MATERIALS AND METHODS

CBCT images of 98 patients with DJD (67 with CSP and 31 without CSP) and 22 asymptomatic participants without DJD were measured retrospectively to compare the osteoarthritic changes and the morphology of TMJ. Quantitative analysis of the TMJ radiographic images was performed to present a comparison between the three inter-group groups and between the two sides of the joints.

RESULTS

The frequencies of the articular flattening and surface erosion occur more often in the preferred side joints of DJD patients with CSP than the contralateral side. In addition, the horizontal angle of condyle, the depth of glenoid fossa (DGF), and the inclination of articular eminence (IAE) were larger in DJD patients with CSP than that in asymptomatic participants (p<0.05). Also, the condylar anteroposterior dimension of preferred side joints was significantly less than that of non-preferred side (p=0.026), while the width of condyles (p=0.041) and IAE (p=0.045) was greater.

CONCLUSIONS

DJD patients with CSP appear to have a higher prevalence of osteoarthritic changes, with the morphological changes such as flat condyle, deep glenoid fossa, and steep articular eminence, which might be considered the characteristic imaging features.

CLINICAL RELEVANCE

This study found that CSP is a predisposing factor for the development of DJD, and attention should be paid to the existence of CSP in DJD patients during the clinical practice.

Differences in clinical and radiographic features between bilateral and unilateral adult degenerative temporomandibular joint disease: A retrospective cross-sectional study

OBJECTIVE

To study the correlations of clinical findings and the severity of osseous alterations between bilateral and unilateral degenerative joint disease (DJD) of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

Forty-eight joints from 35 adult patients with DJD were retrospectively examined. The joints were divided into two groups: bilateral DJD (BDJD) (26 joints) and unilateral DJD (UDJD) (22 joints). We collected data on patient characteristics and symptoms, including pain on palpation, limited mouth opening, pain during mandibular movement, and joint noises. Cone beam Computed Tomography (CBCT) was used to assess bony changes, including maximum condylar bone change, severity of erosion, severity of osteophytes, glenoid fossa changes, and superior joint space measurements. Data were correlated between subgroups.

RESULTS

There was no significant difference between the two groups in terms of age or gender. However, pain on palpation was significantly more common in UDJD joints (81.8%) compared to BDJD joints (53.9%). Limitation of mouth opening was also significantly more common in BDJD cases (61.5%) compared to UDJD cases (22.7%). The number of joints with painless degeneration was more common in BDJD TMJs (38.4%) than in UDJD TMJs (9%). There was no significant difference between the two subgroups with regard to pain during mandibular movements or joint sounds and severity of bony changes.

CONCLUSIONS

This study provided important results outlining clinical the clinical profiles of DJD patients. While painful degeneration was more frequent in UDJD joints, painless degeneration was higher in BDJD joints. Limitation of mouth opening was more common in BDJD patients.

Machine-learning-based detection of degenerative temporomandibular joint diseases using lateral cephalograms

INTRODUCTION

Degenerative temporomandibular joint diseases (DJDs) are common diseases in dental practice, characterized by a series of degenerative processes in the temporomandibular joint. Early clinical detection of DJD by dental practitioners can be beneficial to prevent or alleviate the further progression of the disease. This study aimed to develop a cephalogram-based multidimensional nomogram to screen DJD.

METHODS

A total of 502 patients (170 normal and 332 with DJD) were randomly assigned to a training set (n = 351) or a validation set (n = 151). Thirty-six cephalometric parameters were extracted from the cephalograms to be used as input for a predictive machine-learning algorithm. Multivariable logistic regression was used to construct a combined model for visualization in the form of a nomogram. Receiver operating characteristic curve, calibration testing, and decision curve analyses were conducted to evaluate the performance of the combined model.

RESULTS

A Ceph score consisting of 22 cephalometric parameters were significantly associated with DJD (P <0.01). A combined model that consisted of Ceph scores and clinical features (including age, gender, limited mouth opening, crepitus, etc.) performed well in the receiver operating characteristic curve (area under the curve, 0.893), calibration test, and decision curve analyses, indicating its potential clinical value.

CONCLUSIONS

This study constructed and verified a multidimensional nomogram consisting of Ceph scores and clinical features, which may contribute to the clinical screening of DJD in dental practice. Future studies are needed to test the reliability of the model with similar parameters.

Relationship between Posterior Permanent Dentition Pattern and Radiographic Changes of the Mandibular Condyle

This study assessed the relationship between posterior permanent dentition and radiographic changes of the mandibular condyle. This descriptive, cross-sectional study was conducted on 300 panoramic radiographs of patients over 40 years of age (188 females and 112 males). Panoramic radiographs were evaluated for condylar changes such as flattening, subcortical sclerosis, subcortical cyst, erosion, osteophytes, and generalized sclerosis. Presence of muscle pain and temporomandibular joint (TMJ) pain and sounds, and history of TMJ trauma were also assessed. The occlusal scheme of posterior teeth was analyzed according to the Eichner's index. The frequency of condylar changes was calculated in the right and left sides, and their association with posterior permanent dentition was analyzed by the Chi-square test (alpha = 0.05). The frequency of flattening, muscle pain, TMJ sounds, and erosion was 11.7%, 9.7%, 5.7%, and 3.7% in the right side, respectively. The frequency of flattening, muscle pain, erosion, and subcortical cyst was 12%, 9.3%, 5%, and 5% in the left side, respectively. The frequency of bilateral muscle pain, flattening, TMJ sounds, and TMJ pain was 18%, 16.7%, 11.7%, and 9.3%, respectively. Cases with TMJ trauma, generalized sclerosis, and osteophytes were few. According to the Eichner's index, most patients with condylar changes had classes A and B, and a smaller percentage had class C. No significant difference was noted between healthy individuals and those with condylar changes regarding dentition patterns. No relationship existed between condylar changes and posterior permanent dentition pattern.

The detrimental impact of temporomandibular disorders (mis)beliefs and possible strategies to overcome

AIM

This topical review presents common patients' misbeliefs about temporomandibular disorders (TMD) and discusses their possible impact on the diagnosis, treatment and prognosis. We also discussed the possible influence of the beliefs and behaviors of health care providers on the beliefs of patients with TMD and present possible strategies to overcome the negative impacts of such misbeliefs.

METHODS

This topical review was based on a non-systematic search for studies about the beliefs of patients and professionals about TMD in PubMed and Embase.

RESULTS

Patients' beliefs can negatively impact the diagnosis, treatment, and prognosis of TMD. These beliefs can be modulated by several factors such as culture, psychosocial aspects, gender, level of knowledge, and previous experiences. Moreover, primary health care professionals, including dentists, may lack sufficient experience and skills regarding TMD diagnosis and treatment. Misbeliefs of the health care professionals can be based on outdated evidence that is not supported by rigorous methodological investigations. Education and dissemination of knowledge to patients and the general population are effective for prevention, promotion of health and disruption of the cycle of misinformation and dissemination of misbeliefs.

CONCLUSION

The lack of basic information about TMD and the dissemination of mistaken and outdated concepts may delay the diagnosis, hinder the treatment, and consequently increase the risk of worsening the condition. Education is key to overcome TMD misbeliefs.

Degenerative temporomandibular joint diseases and their relation with sleep and emotional disturbance

OBJECTIVE

The relation of degenerative temporomandibular joint (TMJ) diseases (DJDs) with sleep and emotional disturbance were investigated.

METHODS

CBCT examination of patients (n = 358) with DC/TMD-defined intra-articular temporomandibular disorders was performed and stratified into NN: no DJD and no arthralgia; NA: no DJD with arthralgia; TO: osteoarthrosis; and TR: osteoarthritis. Sleep and emotional disturbance were assessed with the Pittsburgh Sleep Quality Index (PSQI) and Depression Anxiety Stress Scale-21 (DASS-21). Data were evaluated using non-parametric and multivariate logistic regression analyses (α = 0.05).

RESULTS

Distributions of NN, NA, TO, and TR groups were 23.2%, 27.1%,19.0%, and 30.7%, respectively. No significant differences in total-PSQI/DASS scores were detected among the four groups. The presence of pain and stress predicted poor quality sleep with odds ratios of 10.75 and 1.07, accordingly.

CONCLUSION

Sleep quality was affected more by arthralgia and stress than the presence of TMJ DJDs.

Assessment of the Morphology and Degenerative Changes in the Temporomandibular Joint Using CBCT according to the Orthodontic Approach: A Scoping Review

Background. Available knowledge about disorders of temporomandibular joint structures and their association with orthodontic variables are still lacking. Objectives. This article is aimed at to identifying studies and presenting current information on the relationship between morphology diversity and the occurrence of degenerative changes in structures of the temporomandibular joint (TMJ) assessed by cone-beam computed tomography (CBCT) in the context of craniofacial morphology and malocclusion. Search Methods. The review was conducted by analyzing the PubMed (including Medline), Cochrane Library, Web of Science, and Scopus electronic databases up to November 2021 using two different comprehensive search strategies based on keywords as well as additional manual searches. Eligibility Criteria. Selection of the literature was carried out according to the PRISMA-ScR checklist. Methodological quality of the selected studies was evaluated using JBI Critical Appraisal Tool. Results. The electronic databases search revealed 3331 records. After applying the eligibility criteria and JBI assessment, a total of 33 studies were extracted and selected to the study. The review was divided into 4 parts, in which the following correlations were assessed in terms of orthodontic variables: TMJ degenerative changes, joint space and condylar position, condylar shape, TMJ articular eminence, and fossa. Conclusions. Skeletal and dental class II malocclusion with a retrognathic mandible, a hypodivergent skeletal pattern with a steep mandibular plane, and significant lateral mandibular displacement can be risk factors for developing radiographically detectable degenerative changes. Patients with skeletal and dental class III malocclusion as well as a hyperdivergent skeletal pattern may be at greater risk of TMD occurrence compared with other groups. Further studies are necessary to clarify the relationship between the position of the condylar processes and the presence of degenerative changes in the temporomandibular joints among orthodontic patients.

Correlation of clinical manifestations and condylar morphology of patients with temporomandibular degenerative joint diseases

OBJECTIVE

To study the correlation between condylar morphology and clinical manifestations in patients with degenerative joint disease (DJD) of the temporomandibular joint (TMJ).

METHODS

A total of 175 joints of 131 patients with DJD were included. Data on patients' basic information and symptoms were collected and analyzed. Condylar morphology was evaluated using cone beam computed tomography (CBCT). The correlation between the condylar morphology and clinical manifestations was analyzed.

RESULTS

The prevalence of joint noises, clicks, and crepitus was 93/175 (53%), 73/175 (42%), and 20/175 (11%), respectively. Condylar anteroposterior diameter and condylar height were correlated with pain. There was a correlation between the shape of the condyle in the sagittal plane and joint noise.

CONCLUSION

Condylar morphology and clinical features of DJD were correlated to some extent.

Reciprocal effects of scleroderma and temporomandibular dysfunction between patient cohorts

OBJECTIVE

To estimate the prevalence of temporomandibular dysfunction in scleroderma patients according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to correlate it with disease variables.

METHODS

Temporomandibular dysfunction was evaluated in 75 scleroderma patients and 74 healthy controls using DC/TMD. Gastrointestinal symptoms were evaluated through the University of California Los Angeles (UCLA) score in scleroderma patients.

RESULTS

There was no difference of prevalence in temporomandibular dysfunction [30 (40%) vs 30 (40.5%); p > 00.05] between scleroderma patients and healthy controls. Scleroderma patients had a significant reduction in all oral movements compared to healthy controls. Scleroderma patients with temporomandibular dysfunction had a statistically higher score in the UCLA distention/bloating item [1.75 (0.5-2.38) vs 0.75 (0.25-1.75); p < 0.05] than scleroderma patients without temporomandibular dysfunction.

DISCUSSION

Temporomandibular dysfunction prevalence between scleroderma patients and healthy controls is similar. In scleroderma patients, temporomandibular dysfunction reduces oral mobility and opening, which worsens distension/bloating.

Temporomandibular joint findings in CBCT images: A retrospective study

OBJECTIVE

To evaluate radiological characteristics of the temporomandibular joint.

METHODS

Retrospective study of images of 20-80 year-old patients. Two independent clinicians analyzed the images, and a radiological score was obtained, considering sclerosis, osteophites, cysts, and erosion.

RESULTS

Seventy eight percent of the joints belonged to females. The main complaints were pain and headache (54.5%) and reduced motion (21.2%). The most common diagnoses were disc dislocation with reduction (35.9%), myofascial pain (20.7%), and osteoarthritis (15.2%). The majority of the joints (96.5%) showed degeneration, with an average radiological score of 3.86 ± 1.47 (0-8). Non-parametric tests showed that females had significantly higher radiological scores (p = 0.014), and TMD-joint patients had higher scores than TMD-muscle patients (p = 0.013). No statistically significant association between radiological scores and chief complaint.

CONCLUSION

There were differences among the radiological findings between genders and joint/ muscle TMD, as well as across diagnoses, as expected.

Relationship between Clinical Symptoms and Magnetic Resonance Imaging in Temporomandibular Disorder (TMD) Patients Utilizing the Piper MRI Diagnostic System

Clinical problems of the temporomandibular joint (TMJ) and the masticatory musculature are both included in the term temporomandibular disorder (TMD). The purpose of the present study was to examine the pathology of the joints of patients diagnosed with TMD utilizing the dedicated Piper MRI-based classification, and to link these pathologies with various symptoms while considering their severity. In total, 64 patients with clinical TMD were examined. Symptoms were recorded using a questionnaire. The clinical examination included diagnosing the occlusion in centric relation, which was followed by a standardized MRI. It was confirmed that, although they occurred in a high percentage in all classes, muscle pain and occlusal interference are not indicators of TMJ damage. The results indicate that the progressive degradation of the TMJ, represented by qualification to the higher Piper classes, is associated with an increase in TMJ pain only up to a certain stage. For the highest Piper classes, the joint pain occurs in a smaller percentage of patients, but sounds are more frequent.

Analysis of three-dimensional imaging findings and clinical symptoms in patients with temporomandibular joint disorders

Background

The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms.

Methods

A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test.

Results

TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85).

Conclusions

CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.

An Update on Mesenchymal Stem Cell-Centered Therapies in Temporomandibular Joint Osteoarthritis

Temporomandibular joint osteoarthritis (TMJOA) is a degenerative disease characterized by cartilage degeneration, disrupted subchondral bone remodeling, and synovitis, seriously affecting the quality of life of patients with chronic pain and functional disabilities. Current treatments for TMJOA are mainly symptomatic therapies without reliable long-term efficacy, due to the limited self-renewal capability of the condyle and the poorly elucidated pathogenesis of TMJOA. Recently, there has been increased interest in cellular therapies for osteoarthritis and TMJ regeneration. Mesenchymal stem cells (MSCs), self-renewing and multipotent progenitor cells, play a promising role in TMJOA treatment. Derived from a variety of tissues, MSCs exert therapeutic effects through diverse mechanisms, including chondrogenic differentiation; fibrocartilage regeneration; and trophic, immunomodulatory, and anti-inflammatory effects. Here, we provide an overview of the therapeutic roles of various tissue-specific MSCs in osteoarthritic TMJ or TMJ regenerative tissue engineering, with an additional focus on joint-resident stem cells and other cellular therapies, such as exosomes and adipose-derived stromal vascular fraction (SVF). Additionally, we summarized the updated pathogenesis of TMJOA to provide a better understanding of the pathological mechanisms of cellular therapies. Although limitations exist, MSC-centered therapies still provide novel, innovative approaches for TMJOA treatment.

Intermittent intracranial condylar dislocation with minimal functional sequelae

Degenerative changes of the temporomandibular joint (TMJ) present with a broad spectrum of morphological alterations. However, erosions leading to a glenoid fossa defect and condylar impingement of the temporal lobe are a rare finding. A 77-year-old female patient presented with limited mouth opening and pre-auricular pain during mastication on the left side. She denied any neurological dysfunction. Her medical history included poliomyelitis, multiple cancers, and osteonecrosis of the left tibial plateau. Computed tomography revealed advanced degeneration of both TMJs. On the left side, a glenoid fossa fragment was elevated towards the left middle cranial fossa. Real-time dynamic magnetic resonance imaging (MRI) showed repetitive intracranial condylar dislocation during mouth closure. She declined surgery and received instructions for self-management. At the 12-month follow-up, she reported resolution of the pain and normal masticatory function. A control MRI showed a stable radiographic appearance. This report illustrates that intermittent dislocation of the mandibular condyle into the middle cranial fossa can be successfully managed conservatively. The self-limiting nature of the TMJ degenerative joint disease, patient preference, and the patient's general health status require consideration when advising patients on the therapeutic strategy.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

Characteristics of patients with temporomandibular joint osteoarthrosis on magnetic resonance imaging

INTRODUCTION

Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The aim of this study was to investigate the characteristics of the patients with TMJ osteoarthrosis on MR imaging.

METHODS

The MR images of 206 TMJs of 103 patients with temporomandibular disorders (TMD) were evaluated retrospectively in this study. The relationship between osteoarthrosis and age, gender, TMJ pain and MR imaging findings, such as disc displacement with or without reduction and TMJ effusion, was analysed.

RESULTS

The patients with TMJ osteoarthrosis (mean: 51.6 years) were significantly older than those without osteoarthrosis (mean: 44.8 years, P = 0.027). The incidence of the patients with TMJ osteoarthrosis was significantly different between with (10.0 %) and without reduction (57.0 %, P < 0.001). Logistic multivariate regression analysis demonstrated that disc displacement without reduction was significant in patients with TMJ osteoarthrosis (odds ratio = 12.285, P < 0.001).

CONCLUSIONS

This study suggests that characteristics of the patients with TMJ osteoarthrosis on MR imaging include older and disc displacement without reduction.