Condylar resorption

Idiopathic condylar resorption in adolescents: A scoping review

OBJECTIVE

Idiopathic condylar resorption (ICR), also known as progressive condylar resorption, is poorly understood, particularly in adolescent patients. Therefore, this scoping review aims to summarize the available literature on the prevalence, aetiology, pathogenesis, diagnostic process, treatment and/or any outcome regarding ICR in adolescent individuals.

METHODS

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its extension for scoping reviews (PRISMA-ScR), as well as Joanna Briggs Institute studies. The search strategy was defined adopting a core search structure for each source, and the search was performed on MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus and Google Scholar. After duplicate removal, two independent reviewers screened abstracts, followed by complete articles, to achieve the definition of included studies. Data collection was performed, and the extracted data were organized in tabular form, along with a narrative summary of main findings that aligns with the objective of this review.

RESULTS

Six observational studies were included in this review. Three studies focused on signs and symptoms, one on prevalence and signs and symptoms, one on treatment and one on disease pathogenesis.

CONCLUSION

This scoping review revealed inadequate published research regarding prevalence, aetiology, early diagnosis, pathogenesis and treatment of ICR in adolescents.

Changes in occlusal relationships observed using an intraoral scanner in patients with an acquired open bite: A case report

PATIENTS

This case report describes a procedure for assessing changes in occlusal relationships in patients with acquired open bites due to temporomandibular joint disease using an intraoral scanner (IOS). A digital impression was made using the IOS at the initial visit. Subsequent impressions were made every 6 months using the IOS and magnetic resonance imaging (MRI) or computed tomography (CT). Standard triangulated language (STL) image files of two digital impressions at different points in time were superimposed, including the occlusal relationship with reference to the maxillary dentition. Finally, three-dimensional (3D) changes in the occlusal relationship over time were evaluated.

DISCUSSION

In Case 1, the superimposed STL image indicated almost no evident deviation of the mandible. Therefore, an orthodontic treatment was initiated. In contrast, in cases 2 and 3, where changes in the occlusal relationship continued, secondary treatment was postponed and patients continued to be monitored periodically. In case 3, even though left condyle resorption was progressive, the degree of open bite on the right side improved after 6 months. However, the open bite continued to progress for another 6 months despite the stability of the condyle.

CONCLUSIONS

Changes in the condylar shape observed using imaging may not always reflect changes in the occlusal relationship. In addition to changes in the condyles and eminences of the temporomandibular joint (TMJ), changes in the occlusal relationships of patients with acquired open bite should be evaluated using an intraoral scanner.

Three-dimensional analysis of the morphological changes of the craniofacial jaw and condyle in patients with idiopathic condylar resorption

In this study we aim to describe the three-dimensional analysis of condylar deformation of the temporomandibular joint (TMJ) and morphological changes of the craniofacial jaw in patients with idiopathic condylar resorption (ICR). We also compare those with a control group that is healthy and matched for age and gender. Cone-beam computed tomography (CBCT) and cephalometric radiograph (X-ray) were conducted and analysis of craniofacial measurement, condylar width, length, height, and condylar axial angle changes were done three-dimensionally using ProPlan CMF™ 3.0 software (Materialise). The craniofacial jaw measurements of the ICR patients were significantly different than the control group and the significant changes in the mandible can be seen in ICR patients according to the results of this study. The results of smaller condylar width and height in the ICR group reflect the smaller size of the condyle compared with an unaffected condyle. Also, both right and left sagittal condylar angles (p = 0.001 and p = 0.003), respectively, and axial condylar angles (p = 0.01 and p = 0.02), respectively, displayed significant differences between the two groups. In conclusion, the vertical development of the condyle decreased along with reduced measurements in the width and height of the condyle in ICR patients, and differences in the morphology of the craniofacial jaw and condylar angles were observed between study groups.

Combination of hyperlipidemia and 17β-Estradiol induces TMJOA-like pathological changes in rats

OBJECTIVE

We explored whether hyperlipidemia or combination of hyperlipidemia and E2 could induce TMJOA.

MATERIALS AND METHODS

Four groups of female rats were treated with normal diet, normal diet with E2, high-fat diet, and high-fat diet with E2 (HFD/E2), respectively, to induce TMJOA till 8 weeks. Another three groups were then used for COX2 inhibitor celecoxib to block the induction of TMJOA. Primary condylar chondrocytes were treated with combination of E2, ox-LDL, and corresponding inhibitors for evaluating expressions of related molecules.

RESULTS

Condylar cartilage proliferation with plenty of chondrocyte apoptosis and increased staining for LOX1, nuclear NF-κB, IL-1β, and COX2 at 4 weeks and decreased condylar cartilage and increased subchondral bone density at 8 weeks were observed only in the HFD/E2 group. Celecoxib significantly alleviated the cartilage proliferation and apoptosis in the HFD/E2 group. Serum ox-LDL increased in both high-fat diet groups, while serum IL-1β increased only in the HFD/E2 group. Combination of E2 and ox-LDL synergistically induced expressions of LOX1, phosphorylated NF-κB, IL-1β, and COX2, while LOX1 inhibitor blocked the induction of phosphorylated NF-κB, and NF-κB inhibitor the induction of IL-1β, and IL-1β inhibitor the induction of COX2.

CONCLUSION

Combination of hyperlipidemia and E2-induced TMJOA-like pathological changes through LOX1/NF-κB/IL-1β/COX2-signaling pathway.

Characteristics of the Maxillofacial Morphology in Patients with Idiopathic Mandibular Condylar Resorption

Idiopathic mandibular condylar resorption (ICR) is a pathological condition characterized by idiopathic resorption of the mandibular condyle, resulting in a decrease in the size and height of the mandibular condyle. The purpose of this study was to characterize the maxillofacial morphology of ICR patients. Subjects were selected from patients that attended our orthodontic clinic between 1991 and 2019. Twenty-five patients were diagnosed with ICR by magnetic resonance imaging; however, growing patients were excluded. In total, 18 patients were finally selected. The control group comprised 18 healthy volunteers. Lateral and frontal cephalograms were also used. The ICR group had significantly more severe skeletal class II malocclusions than the control group, mainly due to retrusion of the mandible. In the ICR group, there was a tendency for a skeletal open bite due to a significantly larger clockwise rotation of the mandible than in the control group. There was no significant difference between the two groups in the inclination of the upper and lower central incisors or protrusion of the upper and lower central incisors and first molars. ICR patients have been suggested to exhibit skeletal open bite and maxillary protrusion with changes in maxillofacial morphology due to abnormal resorption of the mandibular condyle.

[Condylar displacement following orthognathic surgery]

The overview of the current literature in the research of mandibular condyle displacement after orthognathic surgeries was done. The correct postoperative mandibular condyle position is considered as one of the determinants of the stability of treatment results.

The use of SPECT/CT to assess resorptive activity in mandibular condyles

The aim of this study was to clarify the clinical significance of bone metabolism in the mandibular condyles in determining condylar resorptive changes. Twelve condyles of patients with idiopathic condylar resorption and degenerative joint disease were analysed using ^99mTc HMDP SPECT/CT at baseline and subsequent computed tomography during the follow-up period. Twenty-two healthy condyles were enrolled as controls. After generating three-dimensional SPECT/CT images, two independent observers scored the degree of condylar uptake and measured the morphological changes in the condylar height and condylar volume. In the group with positive condylar uptake, the follow-up computed tomography showed significant decreases in condylar height (-1.69 ± 0.93 mm) and condylar volume (-12.51 ± 10.30%) when compared to healthy controls (condylar height, 0.09 ± 0.54 mm; condylar volume, -0.29 ± 4.22%) (P < 0.001). Moreover, the degree of uptake correlated with the changes in condylar height (observer 1, P = 0.012; observer 2, P = 0.039) and condylar volume (observer 1, P = 0.005; observer 2, P = 0.037). These results suggest that condylar bone metabolism is closely related to the resorptive activity. Thus, SPECT/CT would be useful in the prognostic evaluation or determination of treatment strategies for idiopathic condylar resorption and degenerative joint disease.

Condylar degeneration in anterior open bite patients: A cone beam computed tomography study

OBJECTIVES

The purpose of this study was to investigate the prevalence of condylar degeneration in patients with anterior open bites (AOB).

STUDY DESIGN

Cone beam computed tomography (CBCT) scans of 194 patients with AOB (108 with skeletal open bites and 86 with dental open bites) and 100 patients serving as controls were included in this retrospective study. Two oral and maxillofacial radiologists categorized each of the 588 condyles as normal, degenerative-active, or degenerative-repair. The χ² analysis with Bonferroni adjustment was used to evaluate the relationship of condylar status (normal vs degenerative) to anterior open bites.

RESULTS

Of the 103 degenerative condyles, there were 59 in the group with skeletal open bites, 14 in the group with dental open bites, and 30 in the control group. Condylar degeneration occurred twice as frequently in patients with skeletal open bites as it did in the control group (P < .0001). Conversely, a greater frequency of normal condyles was found in the group of patients with dental open bites (P = .0002). The group with skeletal open bites also showed a significantly higher frequency of bilateral degenerative condyles (P = .0001). The frequency of condylar degeneration did not differ significantly between female and male individuals.

CONCLUSIONS

Degenerative condylar change was significantly more likely in patients with skeletal open bites and less likely in patients with dental open bites.

Long-term stability and condylar remodeling after mandibular advancement: A 5-year follow-up

INTRODUCTION

This study evaluated whether presurgical characteristics, the magnitude of mandibular advancement, and changes in mandibular plane angle are correlated with long-term stability and postsurgical condylar remodeling and adaptations using 3-dimensional imaging.

METHODS

Forty-two patients underwent bilateral sagittal split osteotomies for mandibular advancement using rigid fixation. Cone-beam computed tomography (CBCT) scans were acquired before surgery (T1), immediately after surgery (T2), and at long-term follow-up (T3). The average follow-up period was 5.3 ± 1.7 years after surgery. Anatomic landmark identification on the cone-beam computed tomographies and subsequent quantification of the changes from T1 to T2 and T2 to T3 were performed in ITK-SNAP (version 2.4; itksnap.org) and 3DSlicer (version 4.7; http://www.slicer.org) software. Surgical displacements, mandibular plane angle changes, and skeletal stability were measured relative to cranial base superimposition, whereas condylar remodeling was measured relative to regional condylar registration. Partial correlation coefficients were used to assess relationships between clinical and surgical variables, condylar remodeling, and long-term surgical relapse while controlling for variability in the length of follow-up.

RESULTS

B-point relapsed more than 2 mm posteriorly in 55% of the patients. The only variables strongly associated with the posterior movement of B-point long-term were mesial yaw of the condyle during surgery (P ≤0.01) and the length of follow-up from T2 to T3 (P ≤ 0.01). There was no relationship between the magnitude of advancement or presurgical mandibular plane angle and relapse or condylar resorption. Condylar resorption was strongly associated with relapse of B-point in the posterior direction (P ≤0.01) and clockwise rotation of the mandibular plane long-term (P ≤0.01). Twenty-nine percent of subjects showed resorption of more than 2 mm in the inferior direction at the lateral pole, and 17% of the subjects showed resorption of more than 2 mm in the inferior direction at condylion. Compared with male subjects, females exhibited significantly greater condylar remodeling (P ≤0.01) and slightly greater relapse at B-point (P ≤0.05).

CONCLUSIONS

Surgical relapse at B-point may occur slowly over time and is primarily due to condylar resorption in mandibular advancement patients. Mesial yaw of the condyle during surgery may lead to condylar resorption postsurgically. In addition, females are at greater risk of condylar resorption postsurgically.

Biomechanical analysis of costochondral graft fracture in temporomandibular joint replacement

This study is the first attempt to explore the reason of costochondral graft fracture after lengthy mandible advancement and bilateral coronoidectomy by combining finite element analysis and mechanical test. Eleven groups of models were established to simulate costochondral graft reconstruction in different degrees of mandible advancement, ranging from 0 to 20 mm, in 2 mm increment. Force and stress distribution in the rib-cartilage area were analyzed by finite element analysis. Mechanical test was used to evaluate the resistance of the rib-cartilage complex. Results showed a sharp increase in horizontal force between 8 and 10 mm mandible advancement, from 26.7 to 196.7 N in the left side, and continue increased after 10 mm, which was beyond bone-cartilage junction resistance according to mechanical test. Therefore, we concluded that bilateral reconstruction with coronoidectomy for lengthy mandible advancement (≥ 10 mm) may lead to prominent increase in shear force and result in a costal-cartilage junction fracture, in this situation, alloplastic prosthesis could be a better choice. We also suggested that coronoidectomy should be carefully considered unless necessary.

Volumetric and morphological analysis of condyle and glenoid fossa on computed tomography

AIM

The aim of this study was to evaluate temporomandibular joint (TMJ) condyle and glenoid fossa morphology with measurements on Computed Tomography (CT) and volumetric analysis using InVesalius software program.

MATERIALS AND METHODS

250 condyles in 125 patients (mean age: 40.64) was evaluated on CT. Length, width, and height of the condyle, condylar volume, the thickness of glenoid fossa (TGF), condyle surface area, anterior space (AS), superior space (SS), and posterior space (PS) were measured in this study. Two left and right sides of the jaw have been measured. Linear measurements were performed with the image analysis program (Image J, 1.4 v version, National Institutes of Health, Bethesda, MD). Volume and surface area measurements were performed with InVesalius software (CTI, Campinas, SãoPaulo, Brazil).

RESULTS

To compare the dimensions of the condyle between males and females, there was only a significant difference in left AS and SS and no significant difference was found between males and females in other measured factors. There was a significant difference between the age groups and left SS. A significant difference was also found between the age groups and condylar height, condyle surface area, and condylar volume on both right and left sides.

CONCLUSION

Evaluation of condylar morphology is important to assess the TMJ anomalies and bony changes. This study showed no significant differences between gender and all measured factors except in the left AS and SS. However, age factor had a major effect on the morphology.

Influence of oestrogen deficiency and excessive mechanical stress on condylar head of mandible

OBJECTIVE

We assessed the aetiology of idiopathic condylar resorption by examining the effects of oestrogen and compressive mechanical stress under a low systemic oestrogen condition in temporomandibular joints (TMJ) caused by an ovariectomy.

MATERIALS AND METHODS

Female rabbits were divided into non-ovariectomy (non-OVX) and ovariectomy (OVX) groups. A cortical osteotomy was performed with a custom device that was increased in length by 0.25 mm every 12 hr for 1 week after the operation, during which the TMJs in the rabbits received compressive mechanical stress. Samples from both groups were examined with micro-computed tomography and histological staining.

RESULTS

Area and depth of bone resorption were both greater in the OVX group. Furthermore, a significantly earlier and greater prevalence of sub-condylar bone resorption was noted in that group, while cells positive for tartrate-resistant acid phosphatase were increased in the OVX group.

CONCLUSIONS

The present findings suggest that oestrogen induced a much greater amount of bone resorption on the anterior surface of the condylar head at an earlier stage in the TMJs of the present model rabbits. Thereafter, restoration of TMJ function appeared to occur in a normal manner.

Team approach in the management of revision surgery to correct bilateral temporomandibular joint replacements

This case report describes the successful second surgical treatment of a 26-year-old white female patient with a retrognathic mandible and previous bilateral total joint prostheses placement. The patient had previously presented with bilateral idiopathic condylar resorption (ICR) which caused clockwise mandibular rotation and resulted in anterior open bite and a retrognathic mandible. The patient had undergone definitive corrective for the ICR where condylectomies were performed bilaterally. In addition, total joint prostheses using 'stock joints' were used to restore the condyle and glenoid fossa on both sides. Although the previous surgery corrected the anterior open bite and restored the condyles, the patient was still suffering from joint symptoms (significant pain), restricted mandibular movements, increased overjet (12 mm) and a retrognathic mandible. The treatment plan included a combined orthodontic surgical approach: (1) bimaxillary orthognathic surgery: a surgical procedure on the mandible to reposition the prosthetic joints and correct the mandible position, and a segmental LeFort I to expand the maxilla; and (2) post-surgical orthodontics treatment to detail the occlusion. At the end of the treatment, good aesthetic and functional results were obtained with the cooperation of two specialties. This case emphasises the importance of three-dimensional planning and multidisciplinary treatment when addressing complex jaw movements. It also emphasises the importance orthodontic planning and collaboration with the orthodontist.

[Treatment of dentofacial deformities secondary to condylar resorption]

Treating dentofacial deformities secondary to condylar resorption is a remarkable clinical challenge. Combined orthodontic treatment and orthognathic surgery is currently the main treatment scheme and is often integrated with temporomandibular joint surgery or conservative treatment according to the severity of condylar resorption. This paper discussed the etiology, clinical features, imaging features, treatment options, and prophylaxis of condylar resorption.

Do Patients With Different Mandibular Plane Angles Have Different Time to Relapse After Bilateral Sagittal Osteotomy With Mandibular Advancement?

PURPOSE

This study sought to answer the following question: Do patients with different mandibular plane angles (MPAs) have a different time to relapse after mandibular advancement with bilateral sagittal split osteotomy?

MATERIALS AND METHODS

We performed a retrospective cohort study of patients who underwent bilateral sagittal split osteotomy advancement at Massachusetts General Hospital between 2005 and 2017. The primary predictor variable was MPA, categorized as low (<25°), medium (between 25° and 35°), or high (>35°). The outcome variable was time to relapse (≥2-mm posterior change at the B point). Other covariates included gender, age, temporomandibular joint symptoms, bimaxillary surgery, direction of mandibular rotation, magnitude of advancement, genioplasty, and fixation method. Time to relapse was estimated using the Kaplan-Meier method. Cox and parametric regressions for interval-censored data were performed. P < .05 was considered statistically significant.

RESULTS

The sample was composed of 58 patients (40 female patients), with a mean age of 26.1 ± 4.9 years, grouped as follows: low MPA, n = 15; medium MPA, n = 26; and high MPA, n = 17. Clinically significant relapse was found in 18 patients (31%). Age, temporomandibular joint symptoms, counterclockwise rotation, and magnitude of advancement were statistically significantly different among the 3 groups. When we assessed time to relapse, the Kaplan-Meier method showed that high-MPA patients had a longer mean time at risk and higher estimated probabilities of relapse at different time points compared with low- and medium-MPA patients (P < .05). However, this association was not significant in Cox and parametric regressions.

CONCLUSIONS

Our results suggest that clinically significant relapse was found during the first postoperative year in low-MPA patients and from 2 to 5 years postoperatively in high-MPA patients. Multivariate regression analyses did not show a significant association between MPA and time to relapse, suggesting that other covariates may play a role in the observed time to relapse.

Anterior open bite due to idiopathic condylar resorption during orthodontic retention of a Class II Division 1 malocclusion

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.

Comprehensive treatment approach for bilateral idiopathic condylar resorption and anterior open bite with customized lingual braces and total joint prostheses

This case report describes the successful treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption and resultant mandibular retrusion, increased overjet, and anterior open bite. The nonextraction treatment plan included (1) aligning and leveling the teeth in both arches, (2) performing Le Fort I maxillary osteotomy, bilateral condylectomy, and mandibular joint replacement, and (3) postsurgical correction of the malocclusion. The orthodontic treatment was initiated with the use of custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Patient-fitted and customized temporomandibular joint implants were designed and manufactured based on the patient's stereolithic bone anatomic model. Treatment was concluded with detailed orthodontic finishing. Optimum esthetic and functional results were achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.

Surgical Orthodontic Treatment Involving Mandibular Premolar Extraction in Patient with Mandibular Retrusion Associated with Temporomandibular Joint Osteoarthritis

Here, we report retention following surgical orthodontic treatment in a patient with vertical maxillary excess associated with temporomandibular joint osteoarthritis (TMJOA) and marked mandibular retrusion. The patient was a man aged 20 years 10 months who presented with the chief complaint of maxillary protrusion. The facial profile was of the convex type due to marked mandibular retrusion. In addition, the patient had a gummy smile. Intraoral findings revealed a Class II molar relation, +11 mm overjet, and 0 mm overbite. Mandibular dentition arch length discrepancy showed crowding of -2 mm, and the maxillary dentition showed a spaced arch of +5 mm. Panoramic radiographs confirmed flattening of the condylar head and proliferation of the bone margin. Cephalometric analysis of the skeletal pattern revealed that, horizontally, the maxilla was anterior and the mandible posterior; vertically, a dolichofacial pattern was noted. The anterior maxillary tooth axis was standard, but the anterior mandibular tooth axis showed labial inclination. Based on these findings, skeletal maxillary protrusion associated with TMJOA was diagnosed. Surgical orthodontic treatment comprised bilateral mandibular first premolar extraction with two-jaw surgery and genioplasty. Orthodontic treatment was performed with a multibracket system using a 0.22-slot pre-adjusted edgewise appliance. At 2 years and 11 months after initiation of treatment, the maxilla was transposed 6 mm upwards by orthognathic surgery and the mandible 17 mm anteriorly and 5 mm upwards by counterclockwise rotation. At 3 years and 10 months, the Pogonion was moved 6 mm anteriorly by genioplasty. At 4 years, orthodontic treatment was concluded on confirming satisfactory occlusion and improvement in facial features. At 2 years after completion of treatment, occlusion and the maxillofacial morphology remain stable, with almost no relapse. In addition, no temporomandibular joint disorder symptoms have occurred. Careful comprehensive follow-up observation will be continued.

The transverse facial artery and the mandibular condylar process: An anatomic and radiologic study

INTRODUCTION

In surgical approaches to condylar fractures, there is a risk of damage to the transverse facial artery (TFA) which may in turn account for impaired blood supply to the temporomandibular joint (TMJ). In order to investigate the risk of damage to the TFA, and prevent lesions to this artery resulting from TMJ surgical procedures, we studied the distance between the TFA and the head of the condylar process.

METHODOLOGY

A dissection study was conducted on 10 fresh cadavers (20 condylar specimens dissected), involving fifty CT scans of the face with intravenous contrast. Vertical distance from the TFA to the top of the mandibular condyle head and distance from the TFA to the lateral aspect of the mandibular condyle were measured.

RESULTS

The lateral aspect of the mandibular condyle is vascularized by branches emanating from the superficial temporal artery (STA) and the TFA. The TFA was located 1.84 ± 0.6 cm below the condylar process of the mandible and ran 1.09 ± 0.54 mm lateral to the head of the mandibular condyle.

DISCUSSION

In order to spare the TFA in fractures involving the condylar neck, surgical approaches to the condyle should preserve the uppermost 2 cm of the lateral surface of the condyle during dissection. Due to the necessity for periosteal elevation of the lateral surface of the condyle in condylar head fractures, it is possible to spare the TFA, running lateral to the condylar neck, and the medial condylar surface in order to leave the branches that derive from the maxillary artery (MA) intact.

A comprehensive treatment approach for idiopathic condylar resorption and anterior open bite with 3D virtual surgical planning and self-ligated customized lingual appliance

INTRODUCTION

We report the successful treatment of a 38-year-old woman with bilateral idiopathic condylar resorption and anterior open bite. She had incompetent lips, a gummy smile, increased lower facial height, high mandibular plane angle, skeletal and dental Class II malocclusion with mild mandibular crowding, increased overjet, and mandibular midline deviation to the right.

METHODS

The treatment plan included: (1) presurgical alignment and leveling of the teeth in both arches; (2) jaw motion tracking (JMT) to detect mandibular movement; (3) 3-piece maxillary osteotomies with mandibular reconstruction and bilateral coronoidectomies; and (4) postsurgical correction of the malocclusion. The orthodontic treatment was performed with the use of custom lingual braces and clear brackets and the orthognathic surgery was planned with the use of virtual surgical planning.

RESULTS

The idiopathic condylar resorption and anterior open bite were treated, crowding was eliminated in the lower anterior segment, correction of skeletal and dental Class II malocclusion was obtained, mandibular plane angle was reduced, and facial profile improved.

CONCLUSIONS

The results suggest that esthetic and functional results can be achieved with the cooperation of 2 specialties and with the use of state-of-the-art technology.

Condylar resorption in orthognathic patients after mandibular bilateral sagittal split osteotomy: a systematic review

Objective

To systematically search the literature and assess the available evidence regarding the incidence and quantification of condylar resorption following bilateral sagittal split osteotomy (BSSO) of the mandible in orthognathic patients.

Search methods

Electronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studies.

Selection criteria

Randomized clinical trials (RCTs), prospective, and retrospective studies with patients of any age that underwent BSSO were included.

Data collection and analysis

Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate.

Results

One RCT, 3 prospective, and 10 retrospective studies were included in this review. The lack of standardized protocols and the high amount of heterogeneity precluded a valid interpretation of the actual results through pooled estimates. There was a substantial consistency among studies, however, that young, female patients with mandibular deficiency and high mandibular plane angle, submitted to surgical counterclockwise rotation of mandibular segments, were more prone to a higher risk for condylar resorption after BSSO. The level of evidence was found to be low given the high/serious risk of bias in all included studies.

Conclusions

Condylar resorption should be taken into account as a potential postsurgical complication after BSSO. However, its incidence and quantification need precautious interpretation owing to the low level of evidence and the high heterogeneity of studies. Additional high-quality prospective research assisted by 3D imaging technology is needed to allow more definitive conclusions.

Registration

Study not registered.

Conflict of interest

None.

Dental and skeletal maturation in female adolescents with temporomandibular joint osteoarthritis

Occurrence of temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) osteoarthritis (OA) during adolescence may have interactions with mandibular and dental development. The aim of the present study was to investigate relationships between occurrence of TMD and TMJ OA and extents of dental and skeletal development in juvenile female patients. In total, 95 female adolescents (age range, 11-15 years) were selected. Among them, 15 subjects (control) had no signs of TMD, 39 TMD patients did not have OA (TMDnoOA), 17 TMD patients were at initial stage of TMJ OA (TMJOA), and 27 patients showed progressive stage of TMJ OA (TMJOA). Dental age was estimated by Demirjian's stages used in a previous study with Korean adolescents. Craniofacial parameters and cervical vertebrae maturation (CVM) stages, representing skeletal maturity levels, were measured using lateral cephalograms. The estimated dental age was significantly lower than chronological age in all groups, but CVM differences were not statistically significant. Dental age was the lowest, and differences between the chronological age and estimated dental age were the highest among initial stage of TMJOAs followed by progressive stage of TMJOAs, TMDnoOAs and control and were not associated with CVM stages. Cephalometric parameters revealed significant clockwise rotation of the mandible among the TMJOAs compared with controls and TMDnoOAs and were not associated with CVM stages as well. The juvenile female patients with TMD, particularly TMJ OA, showed retarded dental development, mandibular backward positioning and hyperdivergent facial profiles. The TMJ OA may be associated with retarded dental development but not with skeletal maturations.

Idiopathic condylar resorptions: 3-dimensional condylar bony deformation, signs and symptoms

INTRODUCTION

Our aim was to describe 3-dimensional condylar deformation of the temporomandibular joint (TMJ) and symptoms and signs of temporomandibular dysfunction (TMD) in patients with idiopathic condylar resorption (ICR).

METHODS

We included 25 patients with ICR and 25 controls. We performed cone-beam computed tomographic scans and analyzed condylar width, length, and height as well as the condylar axial angle and the condylar neck angle. TMJ cross sections were evaluated for degenerative characteristics and location of bony deformations. Furthermore, symptoms and signs of TMD were described in the ICR group.

RESULTS

In the ICR group, we found statistically significantly reduced condylar width (mean difference, 2.0 mm), height (mean difference, 4.9 mm), and condylar axial angle (mean difference, 10.6°); 84% of the TMJs had a posterior condylar neck angle (control group, 22%). The most common degenerative changes were noncongruent shape of the condyle-fossa relationship (72%), condylar resorption (56%), and nonintact cortex (40%). More than 70% of the joints with bony deformations showed changes along the entire condylar head. Most patients with ICR showed symptoms and signs of TMD; nevertheless, 12% had no signs or symptoms of TMD.

CONCLUSIONS

ICR in the TMJ changes the shape and reduces the size of the condyle. Deformity locations are unspecified, and the entire condyle is often affected. Most patients with ICR have signs or symptoms of TMD; however, a small group was asymptomatic and without clinical signs.

Condylar geometry variation is associated with ENPP1 variant in a population of patients with dento-facial deformities

PURPOSE

Bone remodeling is essential in maintaining bone health. Considering that ENPP1 contributes to bone geometry and bone mineralization, the aim of our study was to analyze the association between single-nucleotide polymorphisms (SNPs) of ENPP1 and condylar remodeling.

MATERIALS AND METHODS

A total of 156 patients undergoing orthodontic and maxillofacial surgery treatment for correction of malocclusion were included in this prospective study. Saliva samples from all subjects were used for DNA extraction and genotyping. Four ENPP1 SNPs were selected and tested to determine whether specific allelic variants are correlated with condylar remodeling. The criteria of condylar remodeling chosen were the ratio between each side of condylar height or surface differences on a dental panoramic of each patient. A diagnostic threshold was set at 15% difference between both sides.

RESULTS

The ENPP1 SNP rs9373000 showed a statistically significant association with condylar height ratio >15% (p = 0.012). The GG genotype was found to be a protective factor against condylar height decrease (p = 0.003).

CONCLUSION

This study identifies the genetic variant rs9373000 as a potentially causal variant for mandibular condyle geometry variation for patients presenting with dento-facial deformities.

Condylar resorptions and orthodontic-surgical treatment: State of the art

Resorption of the mandibular condyle [RMC] is a disease of the temporomandibular joints, with multifactorial origins. The clinical manifestations take the form essentially of joint pain and occlusal disorders, depending on the rate at which the condyle is affected. X-ray imaging shows that the condyle is reduced in volume, flattened and displaced backwards, with loss of cortical substance in advanced forms. The aim of this article is to recall some pathophysiological features and then to review all the diagnostic and etiological factors and discuss possible modes of management.

[Temporomandibular joint septic arthritis with secondary condylar resorption]

INTRODUCTION

Septic arthritis are serious infections rarely observed for the temporomandibular joint. They are mainly hematogenous or transmitted by contiguity.

OBSERVATION

Our patient presents the case of an infection of the temporomandibular joint by maxillary sinusitis of dental origin further complicated by cerebral abscess and empyema. Initial treatment consisted of an endonasal and intraoral drainage, intravenous empirical antibiotic therapy, a close clinicoradiological monitoring, and rehabilitation following a long-term active physiotherapy. Furthermore, the patient reported the onset of a dental articulation disorder with a left side premature contact and right lateral open bite, corresponding to a significant left condylar resorption.

DISCUSSION

This infectious disease is very rare for temporomandibular location; however, its general and functional outcome is determined by the precocity of the treatment. It is important to know the diagnosis and the associated symptoms even if they are not very specifically described. It is essential to consider the diagnosis when facing atypical pain of the temporomandibular joint associated with trismus.

Juvenile arthritis: current concepts in terminology, etiopathogenesis, diagnosis, and management

The latest change in terminology from juvenile rheumatoid arthritis (JRA) to juvenile idiopathic arthritis (JIA), established by the International League of Associations for Rheumatology (ILAR), has resulted in some confusion for OMFS and other treating clinicians. JIA comprises a group of systemic inflammatory diseases that result in the destruction of hard and soft tissues in a single or multiple joints. In a significant number of patients, one or both temporomandibular joints (TMJ) are also involved. TMJ disease may be accompanied by pain, swelling, and limitation of motion, as well as mandibular retrognathism, open bite, and asymmetry. The purpose of this article is to provide a review, for the oral and maxillofacial surgeon, of the terminology, etiopathogenesis, diagnosis, and management of children with JIA.

Is Alloplastic Temporomandibular Joint Reconstruction a Viable Option in the Surgical Management of Adult Patients With Idiopathic Condylar Resorption?

PURPOSE

Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR.

PATIENTS AND METHODS

A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse.

RESULTS

Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was -10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions.

CONCLUSIONS

Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.

Orthognathic Surgery in Patients With Large Condylar Destructions

Condylar resorption is understood as changes in shape and volume of the condylar bone, due to local, systemic, and iatrogenic factors. The occurrence of condylar resorption after orthognathic surgery can occur when the condylar repositioning in mandibular fossa is performed improperly. In addition, systemic diseases such as osteoarthritis and rheumatoid arthritis seem to influence this process. The aim of this study was to report 3 cases of patients with severe condylar alterations, submitted to orthognathic surgery for treatment of dentofacial deformities. Considerations regarding the diagnosis, surgical planning (counterclockwise rotation), surgical techniques (bilateral sagittal split osteotomy, bimaxillary osteotomies, rigid fixation, maxillomandibular fixation period), and results (short terms) are discussed.

[Replantation of mandibular head using NiTi-based fixing elements]

The article presents clinical observations of 49 patients with high condylar fractures, tumors and tumor-like lesions of the mandible where as the primary treatment method or as an adjunct to endoprosthetics after mandibular resection replantation of the mandibular head was performed using NiTi shape memory appliances to fix the fragments and isolate the replant from the glenoid fossa. Treatment results proved high efficiency of the technology.

Management of dentoskeletal deformity due to condylar resorption: literature review

OBJECTIVES

The aim of this review was to examine all publicly available literature on the current treatments of the dentoskeletal deformity due to condylar resorption and their outcomes and to suggest management guidelines.

STUDY DESIGN

A systematic review was performed of all literature located on the electronic PubMed database from 1970 to 2012.

RESULTS

The search resulted in 21 papers and 210 cases treated from 1991 to 2012. Orthognathic surgery was the most commonly used option (42%) and was sometimes combined with open joint surgery (19%). Stability was observed, respectively, in 57% and 100% of the orthognathic surgery and open joint surgery cases. Condylectomy and reconstruction with chondrocostal graft or temporomandibular joint total joint prosthesis were used in 19% and 10% of all cases of orthognathic surgery and open joint surgery with good results (95% and 100%, respectively). Osteogenic distraction was anecdotic (1%). Nine percent of all cases received conservative treatment.

CONCLUSIONS

Larger comparative studies are necessary to obtain evidence-based recommendations.

Do the changes in muscle mass, muscle direction, and rotations of the condyles that occur after sagittal split advancement osteotomies play a role in the aetiology of progressive condylar resorption?

Changes in cross-sectional area (CSA), volume (indicating muscle strength), and direction of the masseter and medial pterygoid muscles after surgical mandibular advancement were measured, along with the rotation of the condyles after bilateral sagittal split osteotomies (BSSOs) to advance the mandible. Measurements were done on magnetic resonance images obtained before and 2 years after surgery. CSA and volume were measured in five short-face and seven long-face patients (five males, seven females). Muscle direction was calculated in eight short-face and eight long-face patients (eight males, eight females). Short-face patients underwent BSSO only; long-face patients underwent combined BSSO and Le Fort I osteotomies. The CSA and volume decreased significantly (mean 18%) in all patients after surgery. The postoperative muscle direction was significantly more vertical (9°) in long-face patients. Rotations of the proximal segments (condyles) were minimal after 2 years. The results of this study showed that, after BSSO advancement surgery, changes in the masseter and medial pterygoid muscles are not likely to cause increased pressure on the condyles and nor are the minimal rotations of the condyles. It is concluded that neither increased muscle traction nor condylar rotations can be held responsible for progressive condylar resorption after advancement BSSO.

Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders

There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long-term aim was to establish a foundation, vis-à-vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.

Cone-beam computed tomographic evaluation of the condylar remodeling occurring after mandibular set-back by bilateral sagittal split ramus osteotomy and rigid fixation

Objective

To evaluate condylar head remodeling after mandibular set-back sagittal split ramus osteotomy (SSRO) with rigid fixation in skeletal class III deformities. The correlation between condylar head remodeling and condylar axis changes was determined using cone-beam computed tomography (CBCT) superimposition.

Methods

The CBCT data of 22 subjects (9 men and 13 women) who had undergone mandibular set-back SSRO with rigid fixation were analyzed. Changes in the condylar head measurements and the distribution of the signs of condylar head remodeling were evaluated by CBCT superimposition.

Results

The subjects showed inward rotation of the axial condylar angle; reduced condylar heights on the sagittal and coronal planes; and resorptive remodeling in the anterior and superior areas on the sagittal plane, superior and lateral areas on the coronal plane, and anterior-middle and anterior-lateral areas on the axial plane (p < 0.05).

Conclusions

The CBCT superimposition method showed condylar head remodeling after mandibular set-back SSRO with rigid fixation. In skeletal class III patients, SSRO with rigid fixation resulted in rotation, diminution, and remodeling of the condylar head. However, these changes did not produce clinical signs or symptoms of temporomandibular disorders.

An adult case of temporomandibular joint osteoarthritis treated with splint therapy and the subsequent orthodontic occlusal reconstruction

Herein we report treatment for a 19-year-old female patient with severe osteoarthritis of the temporomandibular joint. The patient had severe open bite with a Class II molar relationship. She had limited mouth opening and pain. Clinical examination and magnetic resonance imaging revealed that she had anterior disc displacement without reduction. By splint therapy, limited mouth opening and pain was eliminated, but an anterior open bite developed after the treatment. By orthodontic treatment, an acceptable occlusion was achieved with a Class I molar relationship.