Does Incidence of Temporomandibular Disc Displacement With and Without Reduction Show Similarity According to MRI Results?

Comparison of temporomandibular joint osseous components in unilateral and bilateral cleft lip and palate patients and normal controls: A CBCT study

OBJECTIVE

The objective of this study was to conduct a comparative analysis of the components of the temporomandibular joint in individuals with unilateral, bilateral cleft lip and palate (CLP), and in healthy individuals, utilizing cone beam computed tomography (CBCT) images.

METHOD AND MATERIAL

The present study employed a cross-sectional design and recruited participants aged 18 to 30 years. The participants were categorized into three groups: a control group consisting of 36 individuals without any cleft, a group of 35 patients with unilateral cleft lip and palate (UCLP), and a group of 15 patients with bilateral cleft lip and palate (BCLP). The analysis of CBCT images encompassed the examination of condylar height and angulation, glenoid fossa height and width, articular eminence inclination, as well as joint spaces across all three groups. The Kruskal-Wallis and Mann-Whitney tests were employed to ascertain the significant differences among the three groups.

RESULTS

The UCLP and BCLP groups demonstrated a statistically significant reduction in condylar height and articular eminence inclination in comparison to the control group. Furthermore, a significant difference in the width of the glenoid fossa was seen between the group with clefts and the control group.

CONCLUSION

The CBCT images showed significant differences in several aspects of the temporomandibular joint, including condylar height, articular eminence inclination, and glenoid fossa width, in individuals with cleft palate. These abnormalities can contribute to the development of temporomandibular joint diseases. Therefore, recognizing these distinctions can help prevent further deterioration and progression of temporomandibular disorders (TMD) in CLP patients.

The effect of tooth loss on the temporomandibular joint space: A CBCT study

OBJECTIVE

The tooth loss has a significant impact on the positioning of the condyle in the glenoid fossa and joint spaces of the temporomandibular joint (TMJ). The aim of this study was to assess the association between tooth loss and TMJ spaces using cone beam computed tomography (CBCT) images.

MATERIALS AND METHODS

This retrospective investigation involved the evaluation of CBCT images of the bilateral TMJs in a cohort of 111 individuals, comprising 68 males and 43 women. The dentition of the patients was categorized into three categories, including A (65.4%), B (19.1%), and C (16.4%), based on the Eichner index. Anterior, superior, and posterior joint spaces were then measured in sagittal views. The Kruskal-Wallis test and Mann-Whitney test were employed to identify significant differences among the three Eichner groups.

RESULTS

The findings of the present study suggested that there was no statistically significant variation in the anterior joint space among different Eichner groups within the general population (p = .781). Nevertheless, the superior and posterior joint spaces exhibited statistically significant alterations, as indicated by p-values of .039 and .010, respectively. It was detected that condyles were positioned inferiorly and posteriorly in group C when compared to groups A and B.

CONCLUSION

The present study indicated that greater loss of tooth-supporting zones is associated with posterior and inferior displacement of condyles. Understanding these relationships helps emphasize how crucial it is to replace missing teeth to enhance occlusion support and, in turn, stop the progression and further deterioration of temporomandibular disorders.

Association between Condylar Bone Changes and Eichner Index in Patients with Temporomandibular Dysfunction: A Cone Beam Computed Tomography Study

STATEMENT OF THE PROBLEM

Eichner index is a dental index, which is based on the occlusal contacts between naturally existing teeth in premolar and molar regions. One controversial topic is the association between occlusal status and temporomandibular joint dysfunction (TMD) and its associated degenerative bony changes.

PURPOSE

Through the use of cone-beam computer tomography (CBCT), the current study sought to ascertain the relationship between the Eichner index and condylar bone alterations in TMD patients.

MATERIALS AND METHOD

In this retrospective study, the CBCT images of bilateral temporomandibular joints (TMJs) of 107 patients with TMD were evaluated. The patients' dentition was classified into three groups of A (71%), B (18.7%), and C (10.3%), according to the Eichner index. Radiographic indicators of condylar bone alterations, including as flattening, erosion, osteophytes, marginal sclerosis, subchondral sclerosis, and joint mice, were either present or absent and registered as 1 or 0, respectively. Chi-square test was used to evaluate the link between the condylar bony changes and the Eichner groups.

RESULTS

According to the Eichner index, the most prevalent group was group "A". The most prevalent radiographic finding was "flattening of the condyles" (58%). Condylar bony changes were found to be statistically related to age (p= 0.00). However, no significant relationship was found between sex and condylar bony changes (p= 0.80). There was a significant relationship between the Eichner index and condylar bony changes (p= 0.05).

CONCLUSION

Patients with greater loss of tooth supporting zones have more condylar bony changes.

Morphologic Analysis of Condyle among Different Disc Status in the Temporomandibular Joints by Three-dimensional Reconstructive Imaging: A Preliminary Study

OBJECTIVES

Morphological study is a common approach in the field of anterior disc displacement (ADD) pathology; however, analysis based on three-dimensional reconstructive imaging has not been investigated. This study investigated the association between ADD and the status of the mandibular condyle and articular fossa.

METHODS

Thirty-four patients were divided into three groups: normal articular disc position (NADP), anterior disc displacement with reduction (ADDwR), and anterior disc displacement without reduction (ADDwoR). Multiple grouped comparisons of three different disc statuses were performed by Kruskal-Wallis H test and variance analysis respectively. Receiver-operating characteristic curve was plotted to assess the diagnostic efficacy of the morphological parameters. Multivariate logistic regression analysis was used to investigate the interfering factors of ADD.

RESULTS

The condylar volume (CV) and condylar superficial area (CSA) in the NADP, ADDwR, and ADDwoR groups exhibited obvious changes (P < 0.05). Both CV and superior joint space (SJS) presented a good diagnostic accuracy for NADP-ADDwoR [area under the curve (AUC)_CV = 0.813; AUC_SJS = 0.855)], and ADDwR-ADDwoR (AUC_CV = 0.858; AUC_SJS = 0.801). CSA presented a good diagnostic accuracy for ADDwR-ADDwoR (AUC = 0.813). A multivariate logistic ordinal regression model showed that the CV [odds ratio (OR) = 1.011; regression coefficient (RC) = 0.011, P = 0.018], SJS (OR, 8.817; RC = 2.177; P < 0.001), and medial joint space (MJS) (OR, 1.492; RC = 0.400; P = 0.047) had a significantly impact on the groups.

CONCLUSION

CV, CSA, SJS, and MJS were significantly associated with the different disc status, and the condyle in ADD exhibited 3-dimensionally altered dimensions. They could be considered as promising biometric markers to assess the ADD.

Can dynamic magnetic resonance imaging replace static magnetic resonance sequences in evaluation of temporomandibular joint dysfunction?

Background

Static MRI was used as an effective tool for diagnosis of temporomandibular joint dysfunction instead of invasive techniques such as arthroscopy and arthrography. The purpose of this study was to detect whether dynamic MRI can be used instead of static MRI in diagnosis of TMJ dysfunction or not.

Results

According to disc displacement, anterior disc displacement was detected in 29 joints (36.25%) by both static and dynamic MRIs, and medial and lateral disc displacements were detected only by static MRI. Regarding disc mobility, dynamic MRI detects stuck disc in 4 joints versus 2 joints detected by static MRI (p value 0.008). Condylar translation was abnormal in 18 joints (22.5%) by static MRI and in 26 joints (32.5%) by dynamic MRI (p value < 0.001). The detection rate of articular disc for dynamic MRI was 87.5% versus static MRI 92.5% (p value 0.038), and the detection rate of condylar head for dynamic MRI was 97.5% versus static MRI 100% (p value 0.012).

Conclusion

Dynamic MRI cannot replace static MRI in evaluation of TMJ dysfunction; both of them support each other for accurate diagnosis and better image quality.

Temporomandibular disorder treatment algorithm for otolaryngologists

OBJECTIVE

To review current literature describing the management of temporomandibular disorder (TMD) and to propose an evidence-based algorithm for otolaryngologists.

DATA SOURCES

A literature review using PubMed and Scopus was conducted to identify manuscripts that describe TMJ disorder etiology, diagnostic methods, and management across the fields of otolaryngology, general practice medicine, physical therapy, dentistry, and maxillofacial surgery.

REVIEW METHODS

Two reviewers subjectively evaluated the studies based on the inclusion criteria, incorporating them into a comprehensive algorithm.

CONCLUSIONS

TMD is one of the most common conditions presenting to otolaryngology outpatient clinics. Etiologies of TMD vary widely, including myofascial, intraarticular, neurologic, traumatic, or psychiatric in origin. When conservative measures fail to produce symptom relief, alternative treatments and referral to outside specialists including psychiatry, physical therapy, dentistry, and maxillofacial surgery may be indicated. Premature or inappropriate referrals may lead to patients suffering TMD for extended periods of time, with alternating referrals between various specialists. Thus, we present a TMD treatment algorithm for otolaryngologists to aid in the decision-making process in managing TMD.

IMPLICATIONS FOR PRACTICE

Patients frequently present to otolaryngology outpatient clinics for symptoms of TMD. Multidisciplinary practice may be necessary to effectively treat TMD of varying etiology and severity. Following conservative treatment, appropriate referrals and treatment plans will reduce ineffective use of resources, deferral of treatment, and patient suffering. For this reason, a comprehensive algorithm for otolaryngologists will improve resource utilization and efficiency of treatment to ultimately provide improved treatment outcomes for patients.