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Collin M, Christidis N, Hagelberg S, Arvidsson LZ, Larheim TA, Ernberg M, Hedenberg-Magnusson B. Temporomandibular involvement in children and adolescents with juvenile idiopathic arthritis: a 2-year prospective cohort study. Sci Rep 2024; 14:5512. [PMID: 38448491 PMCID: PMC10917773 DOI: 10.1038/s41598-024-56174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/03/2024] [Indexed: 03/08/2024] Open
Abstract
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.
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Affiliation(s)
- Malin Collin
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden.
- Department of Orofacial Pain and Jaw Function, Folktandvården, Sörmland AB, Mälarsjukhuset, 611 32, Nyköping, Sweden.
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden
| | - Stefan Hagelberg
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Linda Z Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Tore A Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden
| | - Britt Hedenberg-Magnusson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden
- Department of Orofacial Pain and Jaw Function, Folktandvården Stockholms Län AB, 11382, Stockholm, Sweden
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Rotolo RP, d'Apuzzo F, Femiano F, Nucci L, Minervini G, Grassia V. Comparison between ultrasound and magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: A systematic review. J Oral Rehabil 2023; 50:1082-1092. [PMID: 37301975 DOI: 10.1111/joor.13529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objectives of this systematic review were to evaluate the correlation between Ultrasound (US) and Magnetic Resonance Imaging (MRI) in patients with JIA and to investigate the association with Temporomandibular Disorders (TMD). MATERIALS AND METHODS The protocol was registered in PROSPERO (CRD42022312734). Databases Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature were searched. Eligibility criteria were patients with JIA subjected to diagnostic evaluation using US and MRI. No language restrictions were applied. After duplicate study selection, data extraction and risk of bias assessment according to Cochrane were conducted. Data extraction of patients was conducted by two independent authors. RESULTS Five observational studies were included with 217 participants (153 females and 64 males; mean age 11.3 years). The quality of the studies was overall satisfactory. The correlation between US and MRI in children with JIA was 'moderate' in acute arthritis while the chronic arthritis correlated positively in two studies. CONCLUSIONS Even if MRI remains the more accurate imaging modality for the detection of TMJ of patients with JIA, US may be useful to early detect pathological conditions and to address the patient with JIA and putative TMJ involvement to a more accurate diagnosis with MRI and consequent appropriate treatment management. CLINICAL RELEVANCE MRI should be deemed necessary only secondary to less-invasive assessments with US just to confirm the diagnosis or to increase sensitivity, accuracy of positive predictive values detected.
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Affiliation(s)
- Rossana Patricia Rotolo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fabrizia d'Apuzzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Felice Femiano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Grassia
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
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Piancino MG, Rotolo R, Cannavale R, Cuomo G, Masini F, Dalmasso P, D'Apuzzo F, Perillo L, Nucci L. Cranial structure and condylar asymmetry of adult patients with rheumatoid arthritis. BMC Oral Health 2023; 23:269. [PMID: 37161398 PMCID: PMC10170686 DOI: 10.1186/s12903-023-03001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/29/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE The aim of this prospective cross sectional study was to evaluate the cranial structure and condylar asymmetry of adult patients with rheumatoid arthritis (RA) diagnosed after 25 years of age compared to a healthy adult control group. METHODS Eighteen adult patients (57.4 ± 11.4 years) with RA were compared with a control group. Cephalometric analysis and the Habets method for the calculation of the condylar asymmetry were used. The main cephalometric data investigated were focused on the diagnosis of hyperdivergent cranial structure (NSL/ML, NL/ML), backwards rotation of the mandible (Fh/ML), short vertical ramus (Ar:Go), steep mandibular plane (ML/Oc). RESULTS The cephalometric data considered were not significantly different in the RA vs controls except for the steepness of the occlusal plane (NL/Oc), which was steeper in the patients group (P < 0.02) and the ramus of the mandible which was greater in patients. The asymmetry of the condyles was significant (P < 0.003) and different from the control group, but that of the ramus was not. CONCLUSIONS In this study, RA patients diagnosed after 25 years of age did not show a different pattern of growth with respect to the control group. As expected, the condyles showed a difference being asymmetrical in RA patients due to the high turnover of this joint reacting to severe systemic inflammation in conditions of continuous functional work, load and forces. This study follows a previous study with the same research plan conducted on young JIA patients who showed a different pattern of growth of the skull leading to a severe hyperdivergent cranial structure with backward rotation of the mandible; this is mainly due to the insufficient growth of the condylar site exposed to the inflammatory process during development. Unlike JIA patients, this study showed that RA patients follow an individual growth pattern not affected by inflammation, even if they show joint asymmetry.
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Affiliation(s)
- Maria Grazia Piancino
- Department of Surgical Sciences-Orthodontic Division, Italian Research Center, University of Turin, Turin, Italy
| | - Rossana Rotolo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Rosangela Cannavale
- Department of Surgical Sciences-Orthodontic Division, Italian Research Center, University of Turin, Turin, Italy.
| | - Giovanna Cuomo
- Department of Precision Medicine, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Masini
- Department of Medical and Surgical Sciences, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Dalmasso
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Fabrizia D'Apuzzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of the Study of Campania Luigi Vanvitelli, Naples, Italy
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Cirillo S, Regge D, Garagiola U, Tortarolo A, Iorio GC, Spahiu O, Piancino MG. Arthrogryposis multiplex congenita with maxillofacial involvement: a case report. Maxillofac Plast Reconstr Surg 2023; 45:10. [PMID: 36752944 PMCID: PMC9908798 DOI: 10.1186/s40902-023-00378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Arthrogryposis multiplex congenita is a rare condition that mainly involves the lower limbs, characterized by severe joint deformity and contracture, muscular atrophy, and functional impairment. Its clinical manifestations are heterogenous and may involve the maxillofacial district as well. CASE PRESENTATION This case report describes a 20-year-old patient with arthrogryposis multiplex congenita with skeletal crossbite, facial asymmetry, reduced mouth opening and absence of lateral mandibular movement on the left side. After clinical evaluation, the following exams were required: postero-anterior cephalometric tracing, head and neck electromyography, computerized axiography, computed tomography scan, and maxillofacial magnetic resonance imaging. Orthognathodontic evaluation indicated skeletal asymmetry, reduced condylar movements on the left side and abnormally low electromyography activity of the masticatory muscles on the left side. Computed tomography and magnetic resonance imaging revealed unilateral left mandibular hypoplasia, hypotrophy, and fatty infiltration of masticatory muscles on the left side, as well as immobility of the left condyle during mouth opening, and hypoplasia of the left articular disk, which was however not displaced. Surgery was not indicated and conservative orthognathodontic treatment with function generating bite was suggested to balance the occlusal plane, as well as stretching exercises. CONCLUSIONS A rare case of arthrogryposis multiplex congenita with maxillofacial involvement illustrates that a patient-centred, multidisciplinary approach with accurate diagnosis is required to formulate the best treatment plan. Because of the considerable damage to the masticatory muscles, conservative orthognathodontic therapy may be the best treatment option.
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Affiliation(s)
- Stefano Cirillo
- grid.414700.60000 0004 0484 5983Department of Radiology, Mauriziano Umberto I Hospital, Turin, Italy
| | - Daniele Regge
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Umberto Garagiola
- Department of Biomedical Surgical and Dental Sciences Maxillo-Facial and Odontostomatology Unit, School of Orthodontics Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Alessandro Tortarolo
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - Giuseppe Carlo Iorio
- grid.7605.40000 0001 2336 6580Department of Oncology, University of Turin, Turin, Italy
| | - Orges Spahiu
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - Maria Grazia Piancino
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
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Condylar Asymmetry in Children with Unilateral Posterior Crossbite Malocclusion: A Comparative Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111772. [PMID: 36421221 PMCID: PMC9688623 DOI: 10.3390/children9111772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Unilateral posterior crossbite (UXB) is a common, severely asymmetric malocclusion, characterized by maxillary hypoplasia and masticatory dysfunction. The aim of this research is to evaluate the asymmetry of mandibular condyles and rami in children with UXB. This comparative cross-sectional study included 33 children with UXB (girls = 15, boys = 18; mean age ± SD = 8.0 ± 1.3 years.months]) and 33 age- and gender-matched controls (girls = 15, boys = 18; mean age ± SD = 8.4 ± 1.3 years.months]). Pre-treatment OPGs were analyzed by comparing the height of condyles and rami between the sides using the method by Habets et al. (1988); the result was considered significant if the degree of asymmetry was >6%. Children with UXB showed a significantly increased asymmetry of mandibular condyles (mean ± SD = 10.7% ± 9, p < 0.001), but not of rami (mean ± SD = 1.9% ± 2.3), compared to controls. The rami did not show significant asymmetry in either group. The presence of an increased condylar asymmetry index in a developing patient with unilateral posterior crossbite is a sign of altered skeletal growth and should be considered in the diagnostic process and treatment plan.
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Brouxhon SM, O'Banion MK, Dickerson IM, Kyrkanides S. Calcitonin gene‐related peptide: An intra‐articular therapeutic target for TMJ disorders. Clin Exp Dent Res 2022; 8:1158-1166. [PMID: 35700066 PMCID: PMC9562757 DOI: 10.1002/cre2.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives The goal of this project was to evaluate the role of calcitonin gene‐related peptide (CGRP) in the development of arthritis. Methods Herein, we employed somatic mosaic analysis in two different joints by FIV(CGRP) intra‐articular inoculation in the knees or temporomandibular joints (TMJ) of young adult male C57/BL6 mice. FIV(CGRP) is a feline immunodeficiency virus over‐expressing full‐length CGRP. Joint pathology and function were evaluated at the histopathological and behavioral levels. In addition, CGRP signaling was inhibited by intra‐articular inoculation using FIV(CGRP8‐37), such that the inhibitory peptide CGRP(8‐37) was overexpressed 4 weeks after induction of joint inflammation in the TMJ of IL‐1βXAT transgenic mouse model. The mice were evaluated for behavior and killed for evaluation of knee and TMJ pathology. Results Overexpression of CGRP in the joints of wild‐type mice induced the development of joint anomalies, including meniscal hypertrophy and articular pathology, associated with nocifensive behavior. Intriguingly, overexpression of the CGRP(8‐37) inhibitory peptide in the knee and TMJ of IL‐1βXAT transgenic mice with joint inflammation resulted in partial amelioration of the attendant joint pathology. Conclusions The results of this study suggest that CGRP is sufficient and necessary for the development of joint pathology and may serve as an intra‐articular therapeutic target using gene therapy or monoclonal antibody‐based therapies.
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Affiliation(s)
- Sabine M. Brouxhon
- Department of Physiology, School of Medicine Stony Brook University Stony Brook New York USA
| | - M. Kerry O'Banion
- Department of Neuroscience, The Del Monte Institute for Neuroscience University of Rochester School of Medicine & Dentistry Rochester New York USA
- Department of Oral Health Science, College of Dentistry University of Kentucky, and Department of Neurology, University of Rochester School of Medicine & Dentistry Rochester New York USA
| | - Ian M. Dickerson
- Department of Neuroscience, The Del Monte Institute for Neuroscience University of Rochester School of Medicine & Dentistry Rochester New York USA
| | - Stephanos Kyrkanides
- Department of Neuroscience, The Del Monte Institute for Neuroscience University of Rochester School of Medicine & Dentistry Rochester New York USA
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Increased risk of temporomandibular joint disorders and craniofacial deformities in patients with juvenile idiopathic arthritis: a population-based cohort study. Int J Oral Maxillofac Surg 2022; 51:1482-1487. [DOI: 10.1016/j.ijom.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 01/07/2023]
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Abstract
Patients with juvenile idiopathic arthritis (JIA) often have involvement of the temporomandibular joint (TMJ) during their disease course. Active arthritis of the TMJ remains difficult to assess. Clinical signs and symptoms alone are unreliable, and active TMJ arthritis needs confirmation by gadolinium-enhanced MRI. In recent years, changes in treatment approach have occurred. This article discusses the latest evidence on diagnosis and treatment of JIA-associated TMJ arthritis.
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Skeletal Divergence and Condylar Asymmetry in Patients with Temporomandibular Disorders (TMD): A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8042910. [PMID: 34608439 PMCID: PMC8487372 DOI: 10.1155/2021/8042910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Abstract
Introduction This study was aimed at evaluating the association between vertical skeletal patterns, condylar height symmetry, and temporomandibular disorders in adults. Methods The study sample consisted of 200 patients (ages 18-30 years old) retrospectively recruited: 100 with temporomandibular disorders (TMD) and 100 without TMD (control), diagnosed by Diagnostic Criteria for the Temporomandibular Disorders (DC/TMD). For each subject, skeletal divergence was assessed on lateral cephalograms, and condylar height symmetry was evaluated by orthopantomography (Habets' method). Results Subjects with temporomandibular disorders showed a strong association with condylar asymmetry (p < 0.0001) and, for the skeletal pattern variables, hyperdivergence (p < 0.001). A correlation with the female sex was also found (p < 0.04), while there was no difference in terms of age in the 2 groups (p > 0.29). Conclusions Although it does not imply a direct cause-and-effect relationship, the present study suggests condylar asymmetry and hyperdivergent skeletal pattern are more likely to be associated with a higher risk of temporomandibular disorder joint diseases in adult patients.
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Cavagnetto D, Abate A, Caprioglio A, Cressoni P, Maspero C. Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study. Prog Orthod 2021; 22:32. [PMID: 34595615 PMCID: PMC8484372 DOI: 10.1186/s40510-021-00380-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is currently no information on how different mandibular segments are affected by juvenile idiopathic arthritis. The aim of this paper is to assess volumetric differences of different mandibular segments in subjects with unilateral and bilateral JIA and to compare them with non-JIA control volumes. MATERIALS AND METHODS Forty subjects with unilateral TMJ involvement and 48 with bilateral TMJ involvement were selected for the case group and 45 subjects with no known rheumatic comorbidities for the control group. The mandible of each subject was divided according to a validated method into different paired volumes (hemimandible, condyle, ramus and hemibody). RESULTS The ANOVA test revealed a statistically significant difference in all the groups for condylar and ramus volumes, and the pairwise comparison evidenced a statistically significant higher condylar and ramus volume in the control group (1444.47 mm3; 5715.44 mm3) than in the affected side in the unilateral JIA group (929.46 mm3; 4776.31 mm3) and the bilateral JIA group (1068.54 mm3; 5715.44 mm3). Moreover, there was also a higher condylar volume in the unaffected side in the unilateral JIA group (1419.39 mm3; 5566.24 mm3) than in the bilateral JIA group and the affected side in the unilateral JIA group. CONCLUSIONS The affected side of unilateral JIA patients showed statistically significant lower volumes in the hemimandible, in the condyle and in the ramus. The largest total mandibular volume was observed in the control group, followed by the unilateral JIA group and, lastly, by the bilateral JIA group.
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Affiliation(s)
- Davide Cavagnetto
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy. .,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
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Covert L, Mater HV, Hechler BL. Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint. Diagnostics (Basel) 2021; 11:diagnostics11030409. [PMID: 33673675 PMCID: PMC7997293 DOI: 10.3390/diagnostics11030409] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/18/2022] Open
Abstract
The temporomandibular joint (TMJ) is a synovial joint and thus is vulnerable to the afflictions that may affect other joints in the fields of rheumatology and orthopedics. Too often temporomandibular complaints are seen strictly as dental or orofacial concerns. Similarly, patients with known rheumatic disease may not have their TMJs included in routine screening and monitoring protocols. The purpose of this review is to highlight the rheumatic conditions likely to affect the TMJ and outline medical and surgical management in these patients with a focus on the need for continued patient reassessment and monitoring.
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Affiliation(s)
- Lauren Covert
- Department of Pediatrics, Division of Rheumatology, Duke University Hospitals, Durham, NC 27710, USA; (L.C.); (H.V.M.)
| | - Heather Van Mater
- Department of Pediatrics, Division of Rheumatology, Duke University Hospitals, Durham, NC 27710, USA; (L.C.); (H.V.M.)
| | - Benjamin L. Hechler
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospitals, Durham, NC 27710, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University Hospitals, Durham, NC 27710, USA
- Correspondence:
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Assessment of condylar volume and ramus height in JIA patients with unilateral and bilateral TMJ involvement: retrospective case-control study. Clin Oral Investig 2019; 24:2635-2643. [PMID: 31760476 DOI: 10.1007/s00784-019-03122-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objectives of the study are to analyze volumetric differences of condylar volumes in patients with unilateral and bilateral JIA and to compare results with control condylar volumes. MATERIALS AND METHODS Forty-six CBCT images were analyzed for all patients affected by JIA, 37 females and 9 males (mean age 10.8 ± 4.2) with TMJ involvement (19 unilaterally, mean age 10.9 ± 4.5; 27 bilaterally, mean age 10.7 ± 4.5), and 25 CBCT of subjects without diagnosis of JIA were selected as controls (mean age 10.8 ± 4.2 years). In the case of unilateral JIA, condylar volumes and ramus lengths were compared with healthy condyle and with the compromised one. In the case of bilateral JIA, condyle volume and ramus lengths were compared with healthy one. The Shapiro-Wilk test was used to assess whether the data was normally distributed. Paired t test was applied to compare affected and non-affected condyle in the same patients (P < 0.05). Independent t test was used to evaluate whether the difference between the groups were comparable or significantly different (P < 0.05). RESULTS For the unilateral JIA group, significant differences comparing affected and non-affected condyles were found. A statistically significant reduction of the volume of the head, neck, and ramus was found in the affected side (P < 0.01). For the bilateral JIA group, statistically significant differences have been found considering the condylar head and neck, the whole condylar volume, and the ramus length compared with the control group (P < 0.05). CONCLUSIONS Subjects with unilateral JIA have condyles volumetrically smaller than those of the unaffected side and those found in healthy patients. A considerable decrease of the volume of all the anatomical structures considered in the patients with bilateral JIA was found compared with control group. CLINICAL RELEVANCE The study presents the effects of JIA on different anatomical structures highlighting their dimensional changes, whose sequelae are irreversible if not diagnosed and treated early.
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Isola G, Perillo L, Migliorati M, Matarese M, Dalessandri D, Grassia V, Alibrandi A, Matarese G. The impact of temporomandibular joint arthritis on functional disability and global health in patients with juvenile idiopathic arthritis. Eur J Orthod 2019; 41:117-124. [PMID: 29878100 DOI: 10.1093/ejo/cjy034] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of the study was to evaluate the impact of temporomandibular joint (TMJ) arthritis on the functional disability and quality of life in patients affected by juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS Sixty-two consecutive patients with JIA with or without TMJ arthritis and 35 healthy control subjects were enrolled in the study. The demographic data, disease activity and clinical characteristics were obtained from all patients. The functional disability was assessed using the Italian version of the Childhood Health Assessment Questionnaire (C-HAQ). The oral health-related quality of life (OHRQoL) was assessed using the Child Perception Questionnaire (CPQ11-14). Possible determining factors of TMJ arthritis comprised demographic, disease characteristics and scores derived from questionnaires that were assessed by a uni and multivariable logistic regression analysis. RESULTS Compared with patients without TMJs arthritis, JIA patients with TMJ arthritis presented higher functional disability. The multivariable logistic regression analysis performed showed that female subjects (OR = 1.5, P = 0.041), with a JIA duration over 3.9 years (OR = 2.7, P = 0.033) and presenting higher C-HAQ and CPQ11-14 scores (OR = 2.7, P = 0.012 and OR = 2.9, P = 0.015, respectively) were the greatest determining factors for TMJ arthritis. CONCLUSIONS JIA patients with TMJ arthritis presented higher functional disability and lower OHRQoL scores compared with JIA patients without TMJ arthritis. TMJ arthritis was strongly associated with JIA duration and activity, especially in female patients.
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Affiliation(s)
- Gaetano Isola
- Department of Biomedical, Odontostomatological, Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Italy
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Italy
| | | | - Marco Matarese
- Department of Biomedical, Odontostomatological, Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Italy
| | | | - Vincenzo Grassia
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Italy
| | - Giovanni Matarese
- Department of Biomedical, Odontostomatological, Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Italy
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Investigating possible correlation between condylar asymmetry and clinical dysfunction indices in patients with temporomandibular dysfunction using Cone-beam computed tomographic. J Craniomaxillofac Surg 2019; 47:438-442. [DOI: 10.1016/j.jcms.2018.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 11/03/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022] Open
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Piancino MG, Tepedino M, Cavarra F, Bramanti E, Laganà G, Chimenti C, Cirillo S. Condylar long axis and articular eminence in MRI in patients with temporomandibular disorders. Cranio 2018; 38:342-350. [PMID: 30332921 DOI: 10.1080/08869634.2018.1532647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare morphologic findings in MRI and skeletal divergence of a group of patients with temporomandibular joint disorders (TMD) subdivided into condylar symmetric and asymmetric. METHODS Fifty-nine adults (26.7 years old) with TMD were retrospectively recruited. Condylar height symmetry was evaluated by orthopantomography (Habets's method) and used to divide patients into Symmetric and Asymmetric groups; skeletal divergence was assessed on lateral cephalograms. MRI was used to evaluate the condylar long axis' angle, the glenoid fossa morphology, and the degree of disc displacement. RESULTS Asymmetric subjects showed a hyperdivergent skeletal pattern (p = 0.036), asymmetric condylar long axis (p = 0.018), and deeper (p = 0.025) and asymmetric (p = 0.001) glenoid fossa compared to symmetric subjects. CONCLUSION Patients with TMD and condylar asymmetry diagnosed with orthopantomography are more likely to show hyperdivergent skull in cephalometry, condylar asymmetry of both height and major axis, and a steeper glenoid fossa in MRI.
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Affiliation(s)
- Maria Grazia Piancino
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin , Turin, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | | | - Ennio Bramanti
- Department of Biomedical Sciences, University of Messina , Messina, Italy
| | - Giuseppina Laganà
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata , Rome, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | - Stefano Cirillo
- S.C. Diagnostic Radiology, A.O. Ordine Mauriziano Hospital "Umberto I" , Turin, Italy
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Klenke D, Quast A, Prelog M, Holl-Wieden A, Riekert M, Stellzig-Eisenhauer A, Meyer-Marcotty P. TMJ pathomorphology in patients with JIA-radiographic parameters for early diagnosis. Head Face Med 2018; 14:15. [PMID: 30223858 PMCID: PMC6142390 DOI: 10.1186/s13005-018-0173-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is often accompanied by pathomorphological changes to the temporomandibular joint (TMJ). By analyzing orthodontical orthopantomograms of JIA patients the aims of the study were a) classification of condyle changes, b) quantification of bony asymmetries of condylar destruction and c) detection of relationships between disease duration and TMJ-involvement. PATIENTS/METHODS 46 caucasian JIA-patients (28 female; 18 male; < 16.0 years) were enrolled, each joint (n = 92) was morphologically assessed by means of orthopantomogram, quantitatively analysed and compared with duration of general disease. Condyle morphology was assessed using the Billiau scale for severity of destruction [1]. The quantitative analysis was based on ratios of condyle, ramus and mandible height. RESULTS Patients were divided into groups (Group I - slightly affected, n = 36; Billiau severity 0-2; condyle findings: X-ray normal, condyle erosions, condylar flattening; Group II - severely affected, N = 10; Billiau severity 3-4; condyle findings: condylar flattenings and erosions, unilateral/bilateral complete loss of condyles), based on morphological analysis of condylar destruction. Duration of disease was significantly longer in Group II (8.9 ± 5.2 years) than in Group I (4.6 ± 4.7 years). Asymmetries of condyle, ramus and mandible height, quantitatively analysed by contralateral comparison, were significantly more marked in patients of Group II than of Group I. CONCLUSIONS Orthopantomogram imaging can be used in orthodontics clinical routine to detect TMJ-pathologies and is an important reference for monitoring progression of JIA. Classification into severe and slightly affected TMJ is possible by analysis of condylar pathomorphology. An association between degree of destruction, extent of lower jaw asymmetry and disease duration is suggested by the results.
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Affiliation(s)
- Daniela Klenke
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany.
| | - Anja Quast
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany
| | - Martina Prelog
- Paediatric Department, Paediatric Rheumatology, Würzburg University Hospital, Würzburg, Germany
| | - Annette Holl-Wieden
- Paediatric Department, Paediatric Rheumatology, Würzburg University Hospital, Würzburg, Germany
| | - Maximilian Riekert
- Department of Orthodontics, Würzburg University Hospital, Würzburg, Germany
| | | | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Centre Göttingen, Poliklinik für Kieferorthopädie Robert-Koch-Str. 40 D-, 37075, Goettingen, Germany
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Piancino MG, Cannavale R, Dalmasso P, Tonni I, Garagiola U, Perillo L, Olivieri AN. Cranial structure and condylar asymmetry of patients with juvenile idiopathic arthritis: a risky growth pattern. Clin Rheumatol 2018; 37:2667-2673. [PMID: 29931517 DOI: 10.1007/s10067-018-4180-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/10/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465-471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann-Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P < 0.0001, ML/Oc P < 0.004, ArGo/GoGn P = 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P < 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development.
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Affiliation(s)
- Maria Grazia Piancino
- Department of Surgical Sciences-Orthodontic division, Dental School, University of Turin, Turin, Italy. .,, Turin, Italy.
| | - Rosangela Cannavale
- Department of Surgical Sciences-Orthodontic division, Dental School, University of Turin, Turin, Italy
| | - Paola Dalmasso
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Ingrid Tonni
- Orthodontic Division, Dental School, University of Brescia, Brescia, Italy
| | - Umberto Garagiola
- Department of Biomedical Sciences, University of Milan, Milan, Italy
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania, Luigi Vanvitelli, Italy
| | - Alma Nunzia Olivieri
- Department of Woman and Child and General and Specialized Surgery, University of Campania , Luigi Vanvitelli, Italy
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Lim YS, Chung DH, Lee JW, Lee SM. Reliability and validity of mandibular posterior vertical asymmetry index in panoramic radiography compared with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2018; 153:558-567. [PMID: 29602348 DOI: 10.1016/j.ajodo.2017.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purposes of this study were to compare the asymmetry index using panoramic radiography and cone-beam computed tomography for detecting mandibular posterior asymmetry and to evaluate the diagnostic value of the asymmetry index on panoramic radiography. METHODS A total of 43 patients were included in this study. Ten mandibular posterior distances were measured using panoramic radiography and cone-beam computed tomography, and 10 asymmetry index values were calculated. The reliability of each asymmetry index was assessed. For evaluating validity of each asymmetry index using panoramic radiography, the paired t test and the Bland-Altman analysis were used. The accuracy of the asymmetry index and the area under the curve of receiver operator characteristic were calculated. RESULTS The asymmetry index of total ramal height showed good reliability (ICC, >0.888). In condylar height 1, specificity and negative predictive value were low (0.08 and 0.17, respectively), 95% limits of agreement were ±17.9%, and area under the curve was 0.484. In total, ramal height accuracy was 0.86, and areas under the curve were 0.926 to 0.957. CONCLUSIONS For detecting asymmetry of the condyle region, the asymmetry index using panoramic radiography had little diagnostic value, and we recommend using cone-beam computed tomography images. However, the asymmetry index for total ramal height showed good reliability and relatively higher validity, and its diagnostic value was excellent.
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Affiliation(s)
- Young-Sub Lim
- Department of Orthodontics, Graduate School of Dentistry, Dankook University, Cheonan, Korea
| | - Dong-Hwa Chung
- Department of Orthodontics, Graduate School of Dentistry, Dankook University, Cheonan, Korea.
| | - Jin-Woo Lee
- Department of Orthodontics, Graduate School of Dentistry, Dankook University, Cheonan, Korea
| | - Sang-Min Lee
- Department of Orthodontics, Graduate School of Dentistry, Dankook University, Cheonan, Korea
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Kovalko I, Stoustrup P, Twilt M. Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: Challenges in Diagnosis, Treatment, and Outcomes. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0086-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kinard BE, Abramowicz S. Juvenile Idiopathic Arthritis Practice Patterns Among Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg 2017; 75:2333.e1-2333.e8. [PMID: 28822720 DOI: 10.1016/j.joms.2017.07.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/12/2017] [Accepted: 07/11/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this investigation is to assess the current clinical practices by oral and maxillofacial surgeons (OMSs) in the United States regarding diagnosis and treatment of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS We implemented a cross-sectional survey of academic OMSs in the United States via an electronic survey. The survey included respondent demographic data, patient volumes, diagnostic methods, and management practices for children with JIA and TMJ involvement. The results of the survey were analyzed using descriptive statistics. RESULTS The study respondents were composed of 52 surgeons. Most respondents were men (n = 43, 87.8%), were aged 51 to 60 years (n = 20, 39.2%), were in full-time academics (n = 42, 84%), had more than 20 years of experience (n = 26, 50%), and were seeing 1 to 5 patients with JIA per month (n = 21, 46.7%). Most patients were aged 11 to 15 years (n = 22, 61.1%) and were managed with 1 to 2 systemic medications (n = 30, 81.1%). All OMSs reported evaluating TMJ involvement by reviewing patient history, clinical examination, and imaging. The most commonly used imaging modality was panoramic radiographs (n = 24, 63.2%) and magnetic resonance imaging (n = 22, 57.9%). OMSs decided to inject intra-articular medication based on history and symptoms (n = 36, 94.7%). Once in remission, patients were followed up at yearly (n = 12, 36.4%) or 6-month (n = 10, 30.3%) intervals. CONCLUSIONS Our study shows that, in general, there is consensus among US OMSs regarding diagnosis of TMJ involvement in children with JIA. There is less concordance among the respondents regarding treatment. Currently, management of TMJ involvement in children with JIA is mostly based on expert opinions and retrospective studies. This study further highlights the need for randomized clinical trials and multi-institution collaboration to allow for evidence-based diagnosis and treatment.
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Affiliation(s)
- Brian E Kinard
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shelly Abramowicz
- Assistant Professor, Departments of Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
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Lucchese A, Manuelli M, Matarese G, Isola G, Bassani L, Perillo L, Gastaldi G, Gherlone E. Artrite idiopatica giovanile: implicazioni odontostomatologiche. DENTAL CADMOS 2016. [DOI: 10.1016/s0011-8524(16)30079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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