Evaluation of temporomandibular joint disk displacement and its correlation with pain and osseous abnormalities in symptomatic young patients with magnetic resonance imaging

Association between an Increased Serum CCL5 Level and Pathophysiology of Degenerative Joint Disease in the Temporomandibular Joint in Females

Degenerative joint disease of the temporomandibular joints (DJD-TMJ) clinically manifests with symptoms such as orofacial pain, joint sounds and limited jaw movements. Our research group previously reported the functional necessity of a chemokine-chemokine receptor axis of CCL5-CCR5 in osteoclasts. Accumulated studies reported that this axis was involved in the pathogenesis of bone and joint destructive diseases, suggesting CCL5 as a potent biomarker. This study investigated whether or not the serum level of CCL5 can be a biomarker of DJD-TMJ and concomitantly analyzed changes in the serum and urine levels of bone markers to see whether or not changes in the rate of bone metabolism were predisposing. We enrolled 17 female subjects with diagnosed DJD-TMJ and sexually and age-matched 17 controls. The serum CCL5 level in DJD-TMJ subjects was significantly higher than that in the control subjects. Multivariate analyses indicated an association between an augmented CCL5 level and the rate of bone metabolism, especially in relatively young DJD-TMJ subjects without other systemic symptoms. A principal component analysis of serum markers and our pharmacological experiment using a postmenopausal model of ovariectomized rats suggested that an augmented serum CCL5 level specifically reflected DJD-TMJ and that covert changes in the rate of bone metabolism predisposed individuals to DJD-TMJ.

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.

Evaluation of the lateral pterygoid muscle area, attachment type, signal intensity and presence of arthrosis, effusion in the TMJ according to the position of the articular disc

PURPOSE

The aim of this study was to evaluate the lateral pterygoid muscle (LPM) area, attachment type, signal intensity and presence of arthrosis, effusion in the temporomandibular joint (TMJ) by magnetic resonance imaging (MRI) according to the position of the articular disc.

METHODS

The study included a total of 126 TMJs belonging to 69 patients over the age of 18 years who had MRI due to TMJ complaints. The position of the articular disc, the area, attachment type, and signal intensity of the LPM, the presence of arthrosis on the condyle surface, and the presence of effusion in the joint space were evaluated.

RESULTS

The attachment type of the LPM did not show a statistically significant difference according to the position of the articular disc. The groups were not statistically different in terms of LPM intensity. Although the distribution of the LPM area was found to be low in the anterior disc displacement with reduction (R+DD) group and high in the anterior disc displacement without reduction (R-DD) group. It was determined that the rate of arthrosis at the condyle head was significantly higher in the R-DD group compared to the normal disc position group. The incidence of effusion was found significantly higher in the R-DD and R+DD groups than joints with normal disc position.

CONCLUSIONS

Pathological changes in LPM and TMJ can be detected by MRI. In the group with R-DD, the rate of arthrosis at the condyle head, effusion, LPM area, and intensity of the Sup. LPM were higher.

Volumetric analysis of normal condyles and those with disc displacement with reduction in the Indonesian population: A CBCT study

Purpose

Disc displacement can cause resorption of the head of the condyle and affect its volume. This study analysed the volume of normal condyles and those with disc displacement with reduction (DDR) in cone-beam computed tomography (CBCT) scans from the Indonesian population.

Materials and Methods

This study analysed 56 condyles (26 normal and 30 with DDR) from patients who visited the Oral and Maxillofacial Radiology Unit after being referred from the Prosthodontics Unit at Dental Hospital Universitas Padjadjaran from December 2020 to February 2021. Samples were divided into 2 groups (normal and DDR left and right-side condyles) based on the DC/TMD Axis 1 form through the clinical examination results. Both sample groups were exposed to CBCT radiation. The CBCT imaging results in the Digital Imaging and Communications in Medicine format were exported to the open-source ITK-SNAP format to determine condyle volume. Volumetric data from the cortical and trabecular areas of the right or left side condyles were arranged by sex. The independent t-test was used to determine the significance of differences with IBM SPSS version 21.0. Intra- and inter-observer reliability and validity were tested before determining the volume of the condyles.

Results

Normal condyles and DDR condyles showed significant differences in volume (P<0.05). Significant differences were also seen in cortical (P=0.0007) and trabecular (P=0.0045) volumes. There was a significant difference in condylar volume based on sex.

Conclusion

The normal condyle volume was significantly different from the DDR condyle volume in both sexes.

[Dental imaging procedures in the Unified Health System and the expansion of secondary care: series between 2000-2016]

The scope of this paper was to analyze the time series of dental procedures performed between 2000 and 2016 in the Brazilian Unified Health System (SUS). The data were obtained from the Outpatient Information System of the SUS (SIA-SUS). The influence of the 2004 National Oral Health Policy of Ordinance No. 600/2006 (which instituted the financing of Dental Specialty Centers - CEOs), and Ordinance No. 1,234/2013 (Financial incentive for the Program for Enhancement of Quality and Access - PMAQ-CEO) were analyzed. Descriptive analyses of the initial and final years of the time series were presented, assessing trends and seasonality in seven types of imaging procedures. The time series of rates of periapical/bitewing radiographic exams revealed a trend of moderate increase and was the only area in which the impact of the financial implementation policy of the CEOs was observed, though not of the PMAQ-CEO. Extraoral imaging exams, such as panoramic radiography, facial CT/TMJ and TMJ MRI revealed a strong upward trend, despite the very low rates. The conclusion reached is that between 2000 and 2016, the policy of expansion of secondary care increased the use of periapical/bitewing imaging exams.

Prevalence of degenerative disease in temporomandibular disorder patients with disc displacement: A systematic review and meta-analysis

To assess the available literature on the prevalence of degenerative joint disease (DJD) in patients with anterior disc displacement (ADD) of the temporomandibular joint (TMJ), using a systematic review with meta-analysis. Search strategies were performed in the following databases: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO. A search was also carried out in the gray literature. Two independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. Three reviewers independently collected the required information from the included articles. The methodological quality of the selected studies was assessed individually. In accordance with the inclusion and exclusion criteria, 1349 studies were found and 18 articles were included. The total sample size was 3158 TMJs. The sex distribution was predominant for females (1161 females and 345 males). The average age was 46 (range 10-82) years. Among the 1762 TMJs quantitatively assessed, the prevalence of DJD involving disc displacement with reduction (DDWR) was 35%, while for disc displacement without reduction (DDWoR) the prevalence was 66%. The prevalences of different features of DJD were as follows: sclerosis 24.3%, erosion 23.5%, osteophyte 17.9%, and subcortical cyst 7.6%. The prevalence of DJD in temporomandibular disorder patients with disc displacement is around 50% and is higher in DDWoR (66%) than in DDWR (35%). Sclerosis and erosion would be the most expected radiological signs in a developing DJD. Clinicians should adequately address the frequent DJD features associated with disc displacement in terms of diagnostics and therapeutic management.

Increased chemokine RANTES in synovial fluid and its role in early-stage degenerative temporomandibular joint disease

BACKGROUND

Degenerative joint disease (DJD) of the temporomandibular joints (TMJs) in adolescents and young adults is closely associated with disc displacement without reduction (DDw/oR).

OBJECTIVE

This study aimed to determine the pathogenesis of early-stage TMJ DJD induced by DDw/oR.

METHODS

31 female subjects aged 12-30 years were enrolled, comprising 12 patients with DDw/oR without DJD, 13 with DDw/oR and early-stage DJD, and 6 healthy volunteers. The synovial fluid samples of the subjects were screened for 27 inflammatory-related cytokines using multiple cytokine array. Significantly increased cytokines and a key regulator of osteoclastogenesis "receptor activator of nuclear factor-κB ligand" (RANKL) were further determined by sandwich immunoassay. These factors were also assessed for the possible pathophysiologic actions on RAW264.7 cell proliferation, migration, osteoclastogenesis and bone-resorbing activity using Cell Counting Kit-8, Transwell system, tartrate-resistant acid phosphatase staining and osteo assay plates.

RESULTS

Macrophage-derived inflammatory protein-1 beta (MIP-1β) and regulated upon activation normal T cell expressed and secreted (RANTES) were found to vary significantly in relation to the controls. In contrast to an unchanged concentration of RANKL, a strong increase in the level of RANTES was detected in subjects with DDw/oR and early-stage DJD. MIP-1β concentrations were only elevated in subjects with DDw/oR without DJD. Functionally, both MIP-1β and RANTES could enhance macrophage migration in a concentration-dependent manner, while only RANTES exhibited a promoting effect on osteoclast formation and bone-resorbing activity.

CONCLUSIONS

Chemokine RANTES was significantly upregulated and might be a key regulator of osteoclastogenesis contributing to DDw/oR-induced early-stage TMJ DJD.

Temporomandibular Joints' Morphology and Osteoarthritic Changes in Cone-Beam Computed Tomography Images in Patients with and without Reciprocal Clicking-A Case Control Study

Background: Patients referred for orthodontic treatment often present symptoms of temporomandibular joints’ disorders (TMD), predominantly clicking. The objective was to analyze the morphology of the temporomandibular joints in cone-beam computed tomography (CBCT) images based on the presence of reciprocal clicking before orthodontic treatment. Methods: 105 participants took part in the study. 210 temporomandibular joints (TMJs) were allocated into one of two groups regarding the presence of reciprocal clicking. Morphology of condyle’s head, glenoid fossa, and articular eminence as well as condylar head position in the glenoid fossa and osteoarthritic changes in the area of the condylar head were examined for each TMJ in the CBCT images. Statistical analysis was performed with STATISTICA version 12.0. The following tests were performed: U-Mann Whitney, Kruskal-Wallis, t-Student, and chi-square. The statistical significance level was p = 0.05 for all the measurements included. Results: Significantly smaller condylar A-P dimension (p = 0.040) characterized temporomandibular joints with reciprocal clicking. Condyles were substantially more often positioned posteriorly (p = 0.043) and were significantly more often accompanied by subcortical cysts and pathologic osteoarthritic bone changes (p < 0.001). Conclusions: The early stages of internal derangements stay with alterations in morphology and position of TMJs as well as with the presence of osteoarthritic changes.

[Morphometric features of the temporomandibular joints according to MR studies in adult patients with dislocations of the articular discs and malocclusion of the anterior teeth]

THE PURPOSE OF THE STUDY

To study the morphological features of the temporomandibular joints (TMJ) according to MR studies in adult patients with impaired occlusion of the anterior teeth and dislocations of the articular discs.

MATERIAL AND METHODS

The clinical study included 51 patients aged 17 to 47 years (mean age 28.12±7.44 years): 14 men and 37 women. On the basis of a clinical examination and MR findings of TMJ in 30 patients (mean age 26.77±7.48 years; 8 men and 22 women), TMJ dysfunction in the form of dislocation of articular discs was confirmed. In 21 patients (mean age 30.05±7.12; 15 women, 6 men), TMJ dysfunction without dislocation of articular discs was confirmed. The patients measured the value of vertical incisive overlap (overbite). Analyzing data from MR studies of TMJ, we measured the following values of both TMJs of each patient: the depth and transverse size of the articular fossa, the height of the articular tubercles and the transverse size of the head of the lower jaw.

RESULTS

The examined patients with joint dislocations of TMJ had morphological features: statistically significantly deeper and narrower articular fossae, higher articular tubercles and narrower in the sagittal plane of the head of the lower jaw compared to TMJ of patients with dysfunction without dislocation of articular disks. In addition, in patients with articular disk dislocations, a statistically significant (<0.05) increase in vertical incisal overlap was noted.

CONCLUSION

.TMJ in patients with dysfunction in the form of dislocations of articular discs had morphological features that allowed them to be classified as type 3.

Correlation between temporomandibular joint morphometric measurements and gender, disk position, and condylar position

OBJECTIVE

The aim of this study was to correlate the morphometric measurements of the temporomandibular joint, including condylar size, joint space, and articular eminence size, with gender, disk position, and condylar position by using magnetic resonance imaging.

STUDY DESIGN

Overall, 93 patients were evaluated (31.2% males and 68.8% females; age 18-81 years; mean age 41 years). Condylar size (D1), joint space (D2), and eminence size (D3) were measured. Correlations with gender, disk position, and condylar position were calculated.

RESULTS

A statistically significant correlation was found between D2 and gender, with the joint space being significantly larger in the male group (P = .05). There were correlations between D2 and the position of the disk and the position of the condyle (P ≤ .05).

CONCLUSIONS

The results indicate a correlation between male gender and larger joint space. In addition, we found that the joint space size influences the articular disk and condyle position, which can cause disk displacement.

Changes in temporomandibular joint anatomy, changes in condylar translation, and their relationship with disc displacement: magnetic resonance imaging study

Objective

To assess changes in the articular surfaces of the temporomandibular joint (TMJ) and in condylar translation, as detected by magnetic resonance imaging (MRI), determining whether such changes correlate with disc displacement.

Materials and Methods

We retrospectively analyzed the MRI scans of 2076 TMJs of 1038 patients with symptoms of temporomandibular disorder. We attempted to determine whether articular disc deformity and changes in condylar translation, as well as changes in the articular surfaces of the condyle, glenoid fossa, and articular eminence, correlated with disc displacement.

Results

Disc displacement with reduction was associated with changes in the shape of the articular eminence. Disc displacement without reduction was most strongly associated with disc deformity, condylar degeneration, glenoid fossa degeneration, and effusion. Neither decreases nor increases in condylar translation were associated with disc deformity, degenerative bone changes, or disc displacement.

Conclusion

Changes in the shape of the articular eminence seem to predispose to progression of internal derangement of the TMJ.

Is Temporomandibular Joint Disc Displacement without Reduction a Plausible Cause of Condylar Hypoplasia? A Case Report

Background:

The causes of mandibular condylar hypoplasia can be congenital or acquired in nature. Cited local causes of acquired hypoplasia include trauma, infection and irradiation. We report a case of hypoplastic condyle that was attributed to temporomandibular joint (TMJ) disc displacement without reduction (DDwoR).

Clinical Presentation:

A 16-year-old male presented with restricted mouth opening and right TMJ pain for 6 months. He was subsequently diagnosed with DDwoR. Conservative treatment comprising self-care and moist-heat therapy was administered and he was followed for 27 months without any further interventions. During this period, transitions from “normal” morphology to condylar flattening / erosion, and eventually a re-modeled smaller “normal” right TMJ were observed.

Conclusion:

The present case provided initial support that DDwoR could be a plausible cause of condylar hypoplasia in adolescents / young adults.

Correlation between age, gender, and the number of diagnoses of temporomandibular disorders through magnetic resonance imaging: A retrospective observational study

OBJECTIVE

The aim of this study was to evaluate the correlation among age, gender and the number of temporomandibular disorder (TMD) findings.

METHODS

The records from 228 patients with TMD were analyzed for the presence of these findings: morphological changes, disc displacement with reduction (DDWR) and without reduction (DDWOR), bone edema, effusion, and avascular necrosis. Statistical analyses were conducted using multinomial regression with a 5% significance level.

RESULTS

DDWR was the most frequent finding. Group 1 was composed of 94 patients (41.22%), Group 2, of 67 patients (29.38%), and Group 3, of 67 patients (29.38%). Men were significantly less likely to belong to Group 3 than women (p = 0.5517). Older patients were slightly more likely to fall in Groups 2 and 3 than in Group 1.

DISCUSSION

Women were shown to be more susceptible to developing a higher number of concomitant conditions than men, and the number of findings tended to increase with age.

Clinical implications of magnetic resonance imaging in temporomandibular disorders patients presenting ear fullness

OBJECTIVES/HYPOTHESIS

The aim of this study was to investigate whether findings detected by temporomandibular joint magnetic resonance imaging (TMJ-MRI) can provide pathognomonic evidence of temporomandibular disorders (TMD) in patients with nonspecific ear fullness (EF). The association of nonspecific EF with clinical characteristics of TMD based on TMJ-MRI findings was examined.

STUDY DESIGN

Retrospective analysis.

METHODS

Thirty-four subjects (42 ears) who had no detectable otologic problems as a cause of EF were enrolled in this study. Each subject underwent TMJ-MRI to identify pathology of the TMJ as a possible cause of nonspecific EF. All subjects participated in the re-evaluation process following TMD treatment.

RESULTS

Anatomical abnormalities in TMJ-MRI, irrespective of TMD signs, were observed in 34 of the 42 ears (80.9%), such as degenerative change of the TMJ (16 ears), articular disc displacement (11 ears), and joint effusion (seven ears). Specific abnormalities of the TMJ were associated with nonspecific EF, and this symptom showed improvement following individualized TMD treatment in those with internal derangement and/or effusion of the TMJ. However, abnormal TMJ-MRI findings were also observed in seven of nine ears with no TMD signs, and there was no significant association between the presence of TMD signs and abnormal TMJ-MRI findings (χ² = 0.075, P = .784).

CONCLUSIONS

Patients presenting with nonspecific EF may have TMD, which can be effectively diagnosed using TMJ-MRI. The present study revealed the causal relationship between nonspecific EF and abnormal TMJ findings based on MRI. Individualized TMD treatments based on TMJ-MRI led to improved treatment outcomes with special regard to nonspecific EF LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1692-1698, 2018.

Relationships between temporomandibular joint disk displacements and condylar volume

OBJECTIVES

The aim of this study was to assess the relationship between mandibular condylar volume and disk displacement status in adult males and females.

STUDY DESIGN

We evaluated 122 temporomandibular joints in 61 patients using magnetic resonance imaging (MRI) and computed tomography (CT). MRI data were used to assign disk status as normal disk position (NR), disk displacement with reduction (DDR), or disk displacement without reduction (DDNR). CT data were used to calculate total condylar volume and its components, cortical volume, and trabecular volume. The relationships among condylar volume, disk status, and gender were tested with 2-way analysis of variance.

RESULTS

Condylar volumes significantly correlated with disk displacement, tending to decrease as displacement increased. There were significant differences in both total condylar volume and trabecular volume among the DD status (NR > DDR > DDNR), whereas cortical volume was significantly different only between NR/DDR and DDNR (NR/DDR > DDNR). The volume decreases associated with temporomandibular joint DD were found in both males and females, with greater decreases in men than in women as DD progressed.

CONCLUSIONS

Condylar volumes are significantly associated with disk displacement status. Joints with nonreducing disks showed the smallest condylar volumes in both males and females.

Correlation between temporomandibular joint morphology and disc displacement by MRI

OBJECTIVES

The aim was to evaluate the morphology of the temporomandibular joint's (TMJs) disc and condyle as well as its correlation with disc displacement, using MRI.

METHODS

190 TMJs were retrospectively analysed. The condyle morphology of each TMJ was evaluated by two observers using both axial and coronal views, as were their disc morphology and displacement, using sagittal view. Condyle morphology was classified as flat, convex, angled or rounded in the coronal sections and as anterior side flat/posterior side convex, biconvex, anterior side concave/posterior side convex, flat or biconcave in the axial view. Disc morphology was determined as biconcave, biplanar, biconvex, hemiconvex or folded. χ2, Fisher exact and Bonferroni correction tests were used to evaluate the data. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between age and disc displacement.

RESULTS

Anterior disc displacement with reduction; convex condyle morphology in the coronal view; anterior side concave/posterior side convex morphology in the axial view; and biconcave discs were found to be the most prevalent findings. An association was observed between disc morphology and disc displacement (p<0.001). No correlation between condyle morphology and TMJ disc displacement was found (p=0.291 for axial and p=0.14 for coronal views).

CONCLUSIONS

The results of this study suggest that TMJ disc morphology is associated with disc displacement.