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Ottersen MK, Larheim TA, Hove LH, Arvidsson LZ. Imaging signs of temporomandibular joint osteoarthritis in an urban population of 65-year-olds: A cone beam computed tomography study. J Oral Rehabil 2023; 50:1194-1201. [PMID: 37356072 DOI: 10.1111/joor.13547] [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: 06/08/2022] [Revised: 03/29/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Symptoms of osteoarthritis (OA) in the temporomandibular joint (TMJ) may vary and possible causes should be further explored, such as prevalence and characteristics of imaging features. OBJECTIVES Investigate prevalence, gender differences and characteristics of imaging signs of TMJ-OA by cone beam computed tomography (CBCT) in a population-based sample of 65-year-old Oslo citizens. MATERIALS AND METHODS 159 (86 women, 73 men) individuals randomly recruited from a cohort of 460 Oslo citizens were examined with CBCT. The TMJs were categorised as with imaging signs of OA, no OA or indeterminate for OA. RESULTS CBCT signs of TMJ-OA were found in 35% of the 159 participants: 47% of the women and 22% of the men. CBCT signs of TMJ-OA were unilateral in two-thirds of the TMJs and characterised by articular surface flattening and condylar osteophytes. In almost all joints with bone erosive findings, bone productive findings were also found. Participants with and without CBCT signs of TMJ-OA showed no significant difference in TMD pain screener. Fourteen of the 159 participants (9%) had pain-related TMD and 12 (8%) had been in contact with health care services due to TMD. CONCLUSIONS CBCT signs of TMJ-OA was common in this study group of 65-year-old Oslo citizens, found in every second woman and every fifth man. Articular surface flattening and bone productive changes, in particular condylar osteophytes, were the most frequent imaging features. Despite the high frequency of CBCT signs of TMJ-OA, few of the participants had pain-related TMD.
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Affiliation(s)
- Margareth Kristensen Ottersen
- Department of Maxillofacial Radiology, Faculty of Dentistry, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Tore A Larheim
- Department of Maxillofacial Radiology, Faculty of Dentistry, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Linda Z Arvidsson
- Department of Maxillofacial Radiology, Faculty of Dentistry, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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2
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Franceschi RT, Hallett SA, Ge C. Discoidin domain receptors; an ancient family of collagen receptors has major roles in bone development, regeneration and metabolism. FRONTIERS IN DENTAL MEDICINE 2023; 4:1181817. [PMID: 38222874 PMCID: PMC10785288 DOI: 10.3389/fdmed.2023.1181817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
The extracellular matrix (ECM) niche plays a critical role in determining cellular behavior during bone development including the differentiation and lineage allocation of skeletal progenitor cells to chondrocytes, osteoblasts, or marrow adipocytes. As the major ECM component in mineralized tissues, collagen has instructive as well as structural roles during bone development and is required for bone cell differentiation. Cells sense their extracellular environment using specific cell surface receptors. For many years, specific β1 integrins were considered the main collagen receptors in bone, but, more recently, the important role of a second, more primordial collagen receptor family, the discoidin domain receptors, has become apparent. This review will specifically focus on the roles of discoidin domain receptors in mineralized tissue development as well as related functions in abnormal bone formation, regeneration and metabolism.
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Affiliation(s)
- Renny T. Franceschi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Shawn A. Hallett
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Chunxi Ge
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
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3
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Muraoka H, Kaneda T, Hirahara N, Ito K, Okada S, Kondo T. Efficacy of magnetic resonance imaging texture features of the lateral pterygoid muscle in distinguishing rheumatoid arthritis and osteoarthritis of the temporomandibular joint. Dentomaxillofac Radiol 2023; 52:20220321. [PMID: 36594821 PMCID: PMC9944011 DOI: 10.1259/dmfr.20220321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess whether magnetic resonance imaging (MRI) texture features of the lateral pterygoid muscle can distinguish between rheumatoid arthritis (RA) and osteoarthritis (OA) of the temporomandibular joint (TMJ). METHODS The authors extracted 279 texture features from 36 patients with RA and OA from the region of interest set for the lateral pterygoid muscle on short tau inversion recovery (STIR) images using MaZda Ver.3.3. A total of 10 texture features were selected using Fisher's coefficients, as well as probability of error and average correlation coefficients. Data observed to have a non-normal distribution using the Kolmogorov-Smirnov test were compared using the Mann-Whitney U-test. Receiver operating characteristic (ROC) curves were used to assess the ability of the 10 texture features to distinguish RA and OA of the TMJ. RESULTS A total of 10 features (5 Correlation, 3 Run Length Nonuniformity, 1 Sigma, and 1 Teta) were selected from 279 texture features. These texture features revealed significant differences between the RA and OA groups (p < 0.01). The sensitivity, specificity, accuracy, and area under the ROC curve of the texture features for distinguishing RA from OA were 0.78-0.94, 0.89-1.0, 0.86-0.92, and 0.89-0.95, respectively. CONCLUSION MRI texture analysis of the lateral pterygoid muscle may be useful for distinguishing between RA and OA of the TMJ.
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Affiliation(s)
- Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Naohisa Hirahara
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Kotaro Ito
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Shunya Okada
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Takumi Kondo
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
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Al-Ani Z. Temporomandibular Joint Osteoarthrosis: A Review of Clinical Aspects and Management. Prim Dent J 2021; 10:132-140. [PMID: 33722124 DOI: 10.1177/2050168420980977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The symptoms of TMJ Osteoarthrosis/Osteoarthritis(TMJ OA) are characteristic and in most cases specific to the disorder. There is, however, an overlap of symptoms with other TMDs.Treatment of TMJ OA is generally directed towards management of the symptoms as the temporomandibular joint does retain the capacity throughout life to repair and remodel. Non-conservative and invasive treatment is only rarely necessary.It should be remembered that the mandibular condyle retains the capacity to repair and remodel throughout life and patients should be encouraged to bear this in mind. Conservative measures are usually sufficient to treat symptoms and a period of time should be allowed to elapse before undertaking a more aggressive treatment plan, which, in the overwhelming majority of patients, will not be necessary. This disorder should be approached on the terms of 'a quality of life issue' and treatment should be directed towards patient needs.
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Affiliation(s)
- Ziad Al-Ani
- Senior Lecturer, Glasgow Dental Hospital and School
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5
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Alzahrani A, Yadav S, Gandhi V, Lurie AG, Tadinada A. Incidental findings of temporomandibular joint osteoarthritis and its variability based on age and sex. Imaging Sci Dent 2020; 50:245-253. [PMID: 33005582 PMCID: PMC7506092 DOI: 10.5624/isd.2020.50.3.245] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/28/2020] [Accepted: 06/12/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This study investigated the prevalence of temporomandibular joint osteoarthritis (TMJ-OA) using the Research Diagnostic Criteria for Temporomandibular Disorders image analysis criteria, assessed the severity of incidental osteoarthritic changes affecting the TMJ, and evaluated the correlations of sex and age with the prevalence and severity of TMJ-OA. Materials and Methods This retrospective study assessed 145 randomly selected cone-beam computed tomography scans (261 TMJs) from the authors' institutional maxillofacial radiology archive following the application of inclusion and exclusion criteria. The criteria described by Ahmad et al. were used to determine whether each TMJ was affected by OA, and the severity of the osteoarthritic changes was scored for each joint based on the method described by Alexiou et al. The chi-square, McNemar, Bhapkar chi-square, and Stuart-Maxwell chi-square tests were applied to evaluate the significance of the relationships between variables (age and sex). Results Sixteen TMJs (6.1%) had no OA, 74 (28.6%) were indeterminate for OA, and 171 (65.5%) had OA. Flattening and sclerosis were observed in 86.6% and 12.3% of cases, respectively, while resorption was observed in 7.3% of the joints. Only 21 (8.1%) of the examined TMJs had subchondral cysts. Erosion of the articular eminence was observed in 58 (22.1%) cases, while sclerosis and resorption were found in 68 (25.9%) and 16 (6.1%) TMJs, respectively. Conclusion Female patients had a higher prevalence and severity of TMJ-OA than male patients. The prevalence and severity of TMJ-OA increased with age, with peaks in the fifth and seventh decades of life.
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Affiliation(s)
- Adel Alzahrani
- Division of Oral and Maxillofacial Radiology, Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Sumit Yadav
- Division of Orthodontics, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Vaibhav Gandhi
- Division of Orthodontics, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Alan G Lurie
- Division of Oral and Maxillofacial Radiology, Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Aditya Tadinada
- Division of Oral and Maxillofacial Radiology, Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
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Feng SY, Lei J, Chen HM, Wang YX, Yap AUJ, Fu KY. Increased chemokine RANTES in synovial fluid and its role in early-stage degenerative temporomandibular joint disease. J Oral Rehabil 2020; 47:1150-1160. [PMID: 32609901 DOI: 10.1111/joor.13041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Shi-Yang Feng
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
| | - Jie Lei
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
| | - Hui-Min Chen
- National Clinical Research Center for Oral Diseases, Beijing, China.,Department of General Dentistry II, Peking University School & Hospital of Stomatology, Beijing, China
| | - Yi-Xiang Wang
- National Clinical Research Center for Oral Diseases, Beijing, China.,Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Adrian U-Jin Yap
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, Singapore.,Faculty of Dentistry, National University of Singapore, Singapore.,Duke-NUS Medical School and National Dental Research Institute Singapore, National Dental Centre, SingHealth, Singapore
| | - Kai-Yuan Fu
- Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
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Long-term Changes of Temporomandibular Joint Osteoarthritis on Computed Tomography. Sci Rep 2020; 10:6731. [PMID: 32317672 PMCID: PMC7174364 DOI: 10.1038/s41598-020-63493-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/30/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to understand long-term changes of the osteoarthritic temporomandibular joint (TMJ) condyle using computed tomography (CT) and to verify its correlation with clinical characteristics of temporomandibular disorders. Eighty-nine patients (152 joints; 76 female, 13 male) who had taken follow-up CTs (mean follow-up period: 644.58 ± 325.71 days) at least once in addition to their initial evaluation were selected. Cross-sectional demographic and clinical data and longitudinal CT images were collected. Data were analyzed by analysis of variance and logistic regression. Overall destructive change index (number of TMJ condyle sections in which destructive change was observed) decreased from 1.56 to 0.66. Improvement was seen in 93 joints (61.2%) and 27 joints (17.8%) worsened. In the pain positive group, both initial and final destructive change index were significantly higher compared to the pain negative group (p = 0.04). Occlusal stabilization splint therapy and nonsteroidal anti-inflammatory drug administration showed a significant effect on improving the prognosis of TMJ osteoarthritis (p = 0.015 and 0.011). In conclusion, TMJ osteoarthritis showed long-term improvement in the majority of cases. TMJ osteoarthritis accompanied by pain showed unfavorable prognosis with additional bone destruction. Occlusal stabilization splint and nonsteroidal anti-inflammatory drug administration were beneficial on the prognosis of TMJ osteoarthritis.
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Modgil R, Arora KS, Sharma A, Negi LS, Mohapatra S, Pareek S. TMJ Arthritis Imaging: Conventional Radiograph vs. CT Scan - Is CT Actually Needed? Curr Rheumatol Rev 2019; 15:135-140. [PMID: 30259817 DOI: 10.2174/1573397114666180927101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 04/05/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study was conducted to evaluate the efficacy of conventional TMJ imaging in depicting osseous changes in mandibular condyle and glenoid fossa in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) by comparing the finding against CT and with an objective that if conventional TMJ imaging modality can appreciate the osseous changes in RA and OA then what is the need for CT scan. Thus further reducing the patient's radiation dose. MATERIALS AND METHODS A total of 70 patients (40 Rheumatoid Arthritis; 30 Osteoarthritis) were taken in the study aged between 40 - 60 years and divided in to age groups. Then according to clinical history they were divided according to being symptomatic and asymptomatic. Further radiographic examination was carried out. First the trans-cranial view was obtained (conventional view left and right TMJ) and subsequently a CT scan was obtained and the interpretation was carried out to note the osseous changes like erosion, flattening, sclerosis and osteophyte formation. RESULTS After comparison of the two radiographic methods it was observed that both were equally efficacious in evaluating the osseous changes in arthritic patients. CONCLUSION Thus, it was concluded that when both the radiographic methods (conventional and CT scan) are equally efficacious in evaluating the osseous degenerative changes of TMJ in arthritis. Thus we should prefer the conventional technique so that the patient in not exposed to unnecessary radiation dosage.
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Affiliation(s)
- Richa Modgil
- Department of Oral Medicine and Radiology, Eklavya Dental College & Hospital, Kotputli, Rajasthan, India
| | - Karandeep Singh Arora
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences & Research, Mullana, Ambala, Haryana, India
| | - Abhishek Sharma
- Department of Prosthodontics, Crown and Bridge and Implantology, Eklavya Dental College & Hospital, Kotputli, Rajasthan, India
| | - Lalit Singh Negi
- Department of Oral Medicine and Radiology, Saraswati-Dhanwantri Dental College & Hospital, Post Graduate Research Institute, Parbani, Maharashtra, India
| | - Shreeyam Mohapatra
- Department of Oral Medicine and Radiology, SCB Dental College, Cuttack, Bhubaneswar, Odisha, India
| | - Shubhangi Pareek
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Bhubaneswar, Odisha, India
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Effect of internal derangements and degenerative bone changes on the minimum thickness of the roof of the glenoid fossa in temporomandibular joint. Oral Radiol 2019; 36:25-31. [DOI: 10.1007/s11282-019-00373-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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10
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Prevalence of degenerative joint disease of the temporomandibular joint: a systematic review. Clin Oral Investig 2018; 23:2475-2488. [DOI: 10.1007/s00784-018-2664-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 09/25/2018] [Indexed: 11/27/2022]
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11
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Li S, Lei J, Fu KY. [Radiological characteristics of the cyst-like lesion of condyle in temporomandibular joint by cone beam computed tomography]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:498-502. [PMID: 30465342 DOI: 10.7518/hxkq.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the radiological characteristics and classifications of the cyst-like lesion of condyle in temporomandibular joint (TMJ) by cone beam computed tomography (CBCT). METHODS The study was conducted retrospectively on TMJ images from 194 patients who underwent CBCT examinations. Location, size, amount, surrounding bone trabecula, cortical bone white line of cyst-like lesion, and the overall condition of the condylar bone were evaluated. According to the overall condition of the condylar bone, the cyst-like lesion of condyle were divided into typesⅠand Ⅱ. The location, size, amount, surrounding bone trabecula, and cortical bone white line of the two types of cyst-like lesions were compared. RESULTS In 198 condylars of 194 patients, cyst-like lesions were detected in the left side of 94 patients, in the right of 96 patients, and in both sides of 4 patients. The size of lesions ranged from 1.2 mm to 13.5 mm, with an average size of (3.4±1.5) mm. Half of the cyst-like lesions were located underneath the anterior lateral cortical bony layer (99 condylars, 50.0%). Most cyst-like lesions were solitary (149 condylars, 75.3%), while 62.6% (124 condylars) were surrounded by continuous bony white lines. Bone sclerosis could be observed in 160 condylars (80.8%). A total of 132 condyles (66.7%) were accompanied by changes in late-stage osteoarthrosis, while the others were only accompanied by early-stage osteoarthrosis (10 osteoarthrosis, 5.1%) or showed no evidence of osteoarthrosis (56 osteoarthrosis, 28.3%). Statistical difference were observed in the location, amount, and surrounding bone trabecula of the two types of cyst-like lesions. TypeⅠcyst-like lesions had more frequent and bone sclerosis than type Ⅱ, whereas type Ⅱ cyst-like lesions occurred more on condylar internal or condyle neck than typeⅠ. CONCLUSIONS The pathogenesis and mechanism of the two types of cyst-like lesions may be different from each other.
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Affiliation(s)
- Shu Li
- Center for Temporomandibular Diseases & Orofacial Pain, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Jie Lei
- Center for Temporomandibular Diseases & Orofacial Pain, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Kai-Yuan Fu
- Center for Temporomandibular Diseases & Orofacial Pain, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Almashraqi AA, Ahmed EA, Mohamed NS, Halboub ES. An MRI evaluation of the effects of qat chewing habit on the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:272-282.e2. [DOI: 10.1016/j.oooo.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/29/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
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13
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Ge C, Mohamed F, Binrayes A, Kapila S, Franceschi RT. Selective Role of Discoidin Domain Receptor 2 in Murine Temporomandibular Joint Development and Aging. J Dent Res 2017; 97:321-328. [PMID: 29073363 DOI: 10.1177/0022034517738190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Temporomandibular joint (TMJ) disorders are often associated with development of osteoarthritis-like changes in the mandibular condyle. Discoidin domain receptor 2 (DDR2), a collagen receptor preferentially activated by type I and III collagen found in the TMJ and other fibrocartilages, has been associated with TMJ degeneration, but its role in normal joint development has not been previously examined. Using Ddr2 LacZ-tagged mice and immunohistochemistry, we found that DDR2 is preferentially expressed and activated in the articular zone of TMJs but not knee joints. To assess the requirement for Ddr2 in TMJ development, studies were undertaken to compare wild-type and smallie ( slie) mice, which contain a spontaneous deletion in Ddr2 to produce an effective null allele. Analysis of TMJs from newborn Ddr2slie/slie mice revealed a developmental delay in condyle mineralization, as measured by micro-computed tomography and histologic analysis. In marked contrast, knee joints of Ddr2slie/slie mice were normal. Analysis of older Ddr2slie/slie mice (3 and 10 mo) revealed that the early developmental delay led to a dramatic and progressive loss of TMJ articular integrity and osteoarthritis-like changes. Mutant condyles had a rough and flattened bone surface, accompanied by a dramatic loss of bone mineral density. Mankin scores showed significantly greater degenerative changes in the TMJs of 3- and 10-mo-old Ddr2slie/slie mice as compared with wild-type controls. No DDR2-dependent degenerative changes were seen in knees. Analysis of primary cultures of TMJ articular chondrocytes from wild-type and Ddr2slie/slie mice showed defects in chondrocyte maturation and mineralization in the absence of Ddr2. These studies demonstrate that DDR2 is necessary for normal TMJ condyle development and homeostasis and that these DDR2 functions are restricted to TMJ fibrocartilage and not seen in the hyaline cartilage of the knee.
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Affiliation(s)
- C Ge
- 1 Departments of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - F Mohamed
- 1 Departments of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - A Binrayes
- 1 Departments of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,2 Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - S Kapila
- 3 Orthodontics and Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - R T Franceschi
- 1 Departments of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,4 Department of Biological Chemistry, School of Medicine, University of Michigan, Ann Arbor, MI, USA.,5 Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Lei J, Han J, Liu M, Zhang Y, Yap AUJ, Fu KY. Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults. J Craniomaxillofac Surg 2017; 45:408-413. [DOI: 10.1016/j.jcms.2016.12.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/06/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
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15
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Arsan B, Köse TE, Çene E, Özcan İ. Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:382-391. [PMID: 28110941 DOI: 10.1016/j.oooo.2016.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 10/06/2016] [Accepted: 11/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate changes in the trabecular structure of the mandibular condyle in patients with temporomandibular disorders (TMDs) using fractal analysis. STUDY DESIGN A total of 100 patients ages 18 to 73 years were clinically assessed using the Diagnostic Criteria for Temporomandibular Disorders. The control group was age- and sex-matched with the patient group. Panoramic radiographs were obtained using a Kodak 8000 digital device with 73 kVp and 5 mA fixed parameters. The degree of degeneration in the mandibular condyles was calculated. Regions of interest (84 × 84 pixels) were selected within the cortical boundary of the mandibular condyle, and the fractal dimension (FD) was calculated using ImageJ version 1.48. RESULTS Radiographic degenerative changes were more frequently present and more severe in the patient group (P < .001). The mean value of FD was 1.22 ± 0.06 in the patient group and 1.25 ± 0.06 in the control group (P = .001). A significant decrease in FD was observed (P = .001) in the left temporomandibular joints of the patient group, whereas a nonsignificant decrease in FD was observed in the right temporomandibular joints (P = .073) as degenerative changes increased. CONCLUSIONS Lower FD values were associated with more severe degenerative changes in the patient group. The trabecular structure of condyles in patients with TMD exhibited decreased complexity when erosive and sclerotic changes were evident. As a result, fractal analysis enhanced the use of panoramic radiography in detecting degenerative changes in patients with TMD.
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Affiliation(s)
- Belde Arsan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Okan University, Istanbul, Turkey.
| | - Taha Emre Köse
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Erhan Çene
- Department of Statistics, Yıldız Technical University, İstanbul, Turkey
| | - İlknur Özcan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Disk displacement, eccentric condylar position, osteoarthrosis - misnomers for variations of normality? Results and interpretations from an MRI study in two age cohorts. BMC Oral Health 2016; 16:124. [PMID: 27855674 PMCID: PMC5114831 DOI: 10.1186/s12903-016-0319-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/09/2016] [Indexed: 01/25/2023] Open
Abstract
Background Clinical decision-making and prognostic statements in individuals with manifest or suspected temporomandibular disorders (TMDs) may involve assessment of (a) the position of articular disc relative to the mandibular condyle, (b) the location of the condyle relative to the temporal joint surfaces, and (c) the depth of the glenoid fossa of the temporomandibular joints (TMJs). The aim of this study was twofold: (1) Determination of the prevalence of these variables in two representative population-based birth cohorts. (2) Reinterpretation of the clinical significance of the findings. Methods From existing magnetic resonance imaging (MRI) scans of the TMJs that had been taken in 2005 and 2006 from 72 subjects born between 1930 and 1932 and between 1950 and 1952, respectively, the condylar position at closed jaw was calculated as percentage displacement of the condyle from absolute centricity. By using the criteria introduced by Orsini et al. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:489-97, 1998), a textbook-like disc position at closed jaw was distinguished from an anterior location. TMJ morphology of the temporal joint surfaces was assessed at open jaw by measuring the depth of the glenoid fossa, using the method proposed by Muto et al. (J Oral Maxillofac Surg 52:1269-72, 1994). Frequency distributions were recorded for the condylar and disc positions at closed jaw. Student’s t-test with independent samples was used as test of significance to detect differences of condylar positions between the age cohorts (1930 vs. 1950) and the sexes. The significance levels were set at 5%. First, the results from the measurement of the age cohorts were compared without differentiation of sexes, i.e., age cohort 1930–1932 versus age cohort 1950–1952. Subsequently, the age cohorts were compared by sex, i.e., men in cohort 1930–1932 versus men in cohort 1950–1952, and women in cohort 1930–1932 women men in cohort 1950–1952. Results In both cohorts, condylar position was characterized by great variability. About 50% of the condyles were located centrically, while the other half was either in an anterior or in a posterior position. In both female cohorts, a posterior position predominated, whereas a centric position prevailed among men. Around 75% of the discs were positioned textbook-like, while the remaining forth was located anteriorly. Age had no statistically significant influence on condylar or on disc position. Conversely, comparison between the age groups revealed a statistically significant decrease of the depth of the glenoid fossa in both older cohorts. This age-dependent changes may be interpreted as flattening of the temporal joint surfaces. Conclusions We call for a re-interpretation of imaging findings because they may insinuate pathology which usually is not present. Instead, anterior or posterior positions of the mandibular condyle as well as an anterior location of the articular disc should be construed as a variation of normalcy. Likewise, flattening of articular surfaces of the TMJs may be considered as normal adaptive responses to increased loading, rather than pathological degenerative changes. Trial registration Not applicable.
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Massilla Mani F, Sivasubramanian SS. A study of temporomandibular joint osteoarthritis using computed tomographic imaging. Biomed J 2016; 39:201-6. [PMID: 27621122 PMCID: PMC6138784 DOI: 10.1016/j.bj.2016.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 11/04/2015] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to determine the various bony changes in osteoarthritis (OA) of elderly patients who are suffering from temporomandibular joint dysfunction (TMD) and to find if all the changes manifesting in generalized OA were presented in temporomandibular joint (TMJ). Methods Thirty TMJs of fifteen elderly patients who were diagnosed with TMD were selected for the study. Patient with TMD were subjected to computerized tomographic (CT) imaging, and the various bony changes in the TMJ were recorded. Results CT study of TMJ showed that there is a positive evidence of joint involvement in 80% of the cases. In this study, female patients were more commonly affected by OA than the males. The condylar changes (69.93%) are more common than the changes in the articular eminence (6.6%) and condylar fossa (10%). About 56.6% of TMJ in the study was affected by the early manifestations of the OA. Conclusion CT study showed that there is a positive evidence of TMJ involvement in the elderly patients with TMD. The results show that condylar changes are more common than the changes in the articular eminence and condylar fossa. The study also shows that most of the patients are affected by early TMJ OA; hence, initiating treatment at early stages may prevent the disease progression.
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Affiliation(s)
- F Massilla Mani
- Department of Oral Medicine and Radiology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India.
| | - S Satha Sivasubramanian
- Department of Oral Medicine and Radiology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
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Chen S, Lei J, Fu KY, Wang X, Yi B. Cephalometric Analysis of the Facial Skeletal Morphology of Female Patients Exhibiting Skeletal Class II Deformity with and without Temporomandibular Joint Osteoarthrosis. PLoS One 2015; 10:e0139743. [PMID: 26474490 PMCID: PMC4608765 DOI: 10.1371/journal.pone.0139743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose This study evaluated the differences in the facial morphological characteristics of female patients exhibiting skeletal class II deformity with and without temporomandibular joint osteoarthrosis. Methods Eighty-three female patients with skeletal class II deformity were included in this study; these patients were classified into three groups on the basis of the condylar features shown in cone-beam computed tomography scans: normal group, indeterminate for osteoarthrosis group, and osteoarthrosis group. The cephalometric differences among the three groups were evaluated through one-way ANOVA. Results Of the 83 patients, 52.4% were diagnosed with osteoarthrosis, as indicated by the changes in the condylar osseous component. The cephalometric measurements that represented skeletal characteristics, including mandibular position relative to the cranial base, mandibular plane angle (MP-SN), posterior facial height (S-Go), and facial height ratio, were significantly different among the three groups (p < 0.05). The patients in the osteoarthrosis group yielded the smallest S-Go, the highest MP-SN, and the most retruded mandible. Conclusions Temporomandibular joint osteoarthrosis is commonly observed in female patients with skeletal class II deformity. The morphological characteristics of the facial skeleton in patients with bilateral condylar osteoarthrosis may be altered.
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Affiliation(s)
- Shuo Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Jie Lei
- Department of Oral & Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Kai-Yuan Fu
- Department of Oral & Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Xing Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Biao Yi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
- * E-mail:
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Al-Ekrish AA, Alfaleh WM. Comparative study of the prevalence of temporomandibular joint (TMJ) osteoarthritic changes in cone beam computed tomograms of temporomandibular disorder (TMD) and non-TMD patients: Authors' reply. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:534-6. [DOI: 10.1016/j.oooo.2015.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
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Cömert Kiliç S, Kiliç N, Sümbüllü M. Temporomandibular joint osteoarthritis: cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg 2015; 44:1268-74. [DOI: 10.1016/j.ijom.2015.06.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/21/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
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Comparative study of the prevalence of temporomandibular joint osteoarthritic changes in cone beam computed tomograms of patients with or without temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:78-85. [PMID: 26093683 DOI: 10.1016/j.oooo.2015.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/25/2015] [Accepted: 04/14/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare the prevalence of temporomandibular joint (TMJ) osteoarthritic changes in cone beam computed tomography (CBCT) images of temporomandibular disorder (TMD) and non-TMD patients. STUDY DESIGN A retrospective analysis of CBCT images of the joints of TMD and non-TMD patients was performed. The presence or absence of osteoarthritic changes (condylar erosion, osteophyte, subcortical cyst, or generalized sclerosis) in each TMJ was evaluated. The prevalence within the two study groups were compared by using Chi-square statistics. RESULTS At least one type of osteoarthritic change was present in78.6% of joints in the TMD group and 79.7% in the non-TMD group. No significant difference was found in prevalence of osteoarthritic changes between the TMD and non-TMD groups in the overall study sample or within the subsets of gender and age in the groups. CONCLUSIONS The lack of a significant difference in prevalence of TMJ osteoarthritic changes in TMD and non-TMD patients highlights the equivocal relationship between osseous TMJ morphology and degenerative bone disease.
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Kodama S, Otonari-Yamamoto M, Sano T, Sakamoto J, Imoto K, Wakoh M. Signal intensity on fluid-attenuated inversion recovery images of condylar marrow changes correspond with slight pain in patients with temporomandibular joint disorders. Oral Radiol 2014; 30:212-218. [PMID: 25177105 PMCID: PMC4145205 DOI: 10.1007/s11282-014-0165-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 12/23/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Edema and necrosis of the temporomandibular joint (TMJ) have been described in terms of bone marrow signal abnormalities in magnetic resonance imaging (MRI). However, painful joints often show no such signaling abnormalities, making the diagnosis of TMJ disorders difficult in the clinical setting. An association has been suggested between TMJ bone marrow change and TMJ pain, but even when such change results in slight pain, it may be too slight to be visually apparent on MR images. We hypothesized that fluid-attenuated inversion recovery (FLAIR) can be used to detect such minimal changes. The purpose of this study was to determine whether there is an association between signal intensity on FLAIR images and pain in the TMJ. METHODS The study included 85 TMJs in 45 patients referred to our department for MRI. The signal intensity on FLAIR images was measured. Pain was evaluated based on the visual analog scale. An unpaired t test and Pearson's product-moment correlation coefficient were used for the statistical analysis. A p value of <0.05 was considered statistically significant. RESULTS Signal intensity on the FLAIR images was significantly higher in painful than in nonpainful TMJs, although a significant correlation was not observed between the signal intensity and the pain score. CONCLUSIONS The results of this study suggest an association between abnormalities in the marrow of the mandibular condyle and pain. They also indicate that FLAIR imaging is a useful tool in the clinical diagnosis of painful TMJs.
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Affiliation(s)
- Sayaka Kodama
- Department of Physiology, Tokyo Dental College, Misakichyo 2-1-14, Chiyoda-ku, Tokyo, 101-0061 Japan
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo, Japan
| | | | - Tsukasa Sano
- Division of Radiology, Department of Oral Diagnostic Sciences, Showa University School of Dentistry, Tokyo, Japan
| | - Junichirou Sakamoto
- Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Imoto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo, Japan
| | - Mamoru Wakoh
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo, Japan
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Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Dent Clin North Am 2013; 57:405-418. [PMID: 23809300 DOI: 10.1016/j.cden.2013.04.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The focus of this article is diagnostic imaging used for the evaluation of temporomandibular disorders and orofacial pain patients. Imaging modalities discussed include conventional panoramic radiography, panoramic temporomandibular joint imaging mode, cone beam computed tomography, and magnetic resonance imaging. The imaging findings associated with common diseases of the temporomandibular joint are presented and indications for brain imaging are discussed. Advantages and disadvantages of each imaging modality are presented as well as illustrations of the various imaging techniques.
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Affiliation(s)
- Allison Hunter
- Department of Oral Health and Diagnostic Sciences, College of Dental Medicine, Georgia Regents University, GC 2248, 1120 15th Street, Augusta, GA 30912-1241, USA.
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Cho BH, Jung YH. Osteoarthritic changes and condylar positioning of the temporomandibular joint in Korean children and adolescents. Imaging Sci Dent 2012; 42:169-74. [PMID: 23071967 PMCID: PMC3465759 DOI: 10.5624/isd.2012.42.3.169] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/07/2012] [Accepted: 06/14/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the prevalence of osteoarthritic changes and condylar positioning of the temporomandibular joint (TMJ) in Korean children and adolescents with or without temporomandibular disorders (TMDs). Materials and Methods A total of 101 asymptomatic and 181 symptomatic children and adolescents aged 10 to 18 years old were included in the study. Osteoarthritic changes such as flattening, sclerosis, osteophytes, or erosion, and the parasagittal positioning of the condyle were assessed using cone-beam computed tomography (CBCT) images. Results The overall prevalence of osteoarthritic changes was higher in symptomatic (26.8%) than in asymptomatic adolescents (9.9%) (p<0.05). In the symptomatic group, the frequency was higher in males (33.3%) than in females (23.0%) (p<0.05). Erosion was the most common change for the symptomatic group (15.6%), whereas sclerosis was the most common change for the asymptomatic group (5.4%). Posterior condylar position was more frequently observed in the symptomatic group (p<0.05). Erosion was more common in the samples with TMJ pain or mouth opening limitations as compared to those without them (p<0.05). Conclusion This study showed that osteoarthritic changes in TMJ were common in children and adolescents, with a much higher prevalence in symptomatic patients.
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Affiliation(s)
- Bong-Hae Cho
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
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25
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Barghan S, Tetradis S, Mallya S. Application of cone beam computed tomography for assessment of the temporomandibular joints. Aust Dent J 2012; 57 Suppl 1:109-18. [PMID: 22376103 DOI: 10.1111/j.1834-7819.2011.01663.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Radiographic examination is essential for the diagnosis and management of temporomandibular joint (TMJ) disorders. The goals of TMJ radiography are to evaluate cortical and trabecular architecture of the bony structures and confirm their integrity, to assess the extent and monitor progression of osseous changes, and to evaluate the response to treatment. Accurate evaluation of the TMJ by conventional radiography is limited by structure superimposition. Cone beam computed tomography (CBCT) provides high-resolution multiplanar images and delivers substantially lower radiation dose, compared with multislice CT. CBCT allows examination of TMJ anatomy without superimposition and distortion to facilitate analysis of bone morphology, joint space and dynamic function in all three dimensions. This article will describe the role of CBCT imaging for the assessment of the TMJ osseous structures and present typical appearances of common pathological conditions of the TMJ.
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Affiliation(s)
- S Barghan
- Section of Oral and Maxillofacial Radiology, School of Dentistry, The University of California, Los Angeles, USA
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Evaluating the correlation between the lateral pterygoid muscle attachment type and internal derangement of the temporomandibular joint with an emphasis on MR imaging findings. J Craniomaxillofac Surg 2012; 40:459-63. [DOI: 10.1016/j.jcms.2011.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/31/2011] [Accepted: 08/02/2011] [Indexed: 11/20/2022] Open
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Temporomandibular joint (TMJ) pain revisited with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Eur J Radiol 2012; 81:603-8. [DOI: 10.1016/j.ejrad.2011.01.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 01/03/2011] [Indexed: 11/21/2022]
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Rando C, Waldron T. TMJ osteoarthritis: a new approach to diagnosis. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2012; 148:45-53. [PMID: 22371124 DOI: 10.1002/ajpa.22039] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 01/09/2012] [Accepted: 01/18/2012] [Indexed: 11/10/2022]
Abstract
Disorders of the temporomandibular joint (TMJ), including TMJ osteoarthritis (TMJ OA), are the topic of intensive clinical research; however, this is not the case in the archaeological literature, with the majority of work on the subject ceasing with the early 1990s. The methods employed in the diagnosis of TMJ OA within the archaeological work appear nonrepresentative of the disease and may have led to erroneous assumptions about the pattern and prevalence of OA. This current work presents a new method for evaluating OA specifically for the TMJ, considering both the biomechanics of the joint and the mechanisms of the disease. Totally, 496 specimens (including a group of modern documented specimens) were analyzed for the presence of TMJ OA using the following criteria: eburnation, osteophytes (marginal and new bone on joint surface), porosity, and alteration to joint contour. The results suggest that eburnation occurs rarely in the TMJ, so should not be used as an exclusive criterion. Rather a combination of at least two of the other criteria should be used, with osteophytes and porosity occurring the most frequently on both the mandibular condyle and articular eminence. Additionally, the prevalence of TMJ OA in the modern assemblage was similar to that observed in current clinical research, suggesting that the method employed here was able to produce a reasonable approximation of what is found in contemporary living populations.
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Affiliation(s)
- Carolyn Rando
- UCL Institute of Archaeology, University College London, UK.
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Kim HS, Lee SH, Youn T, Kim HG, Huh JK. Anterior open bite with temporomandibular disorders treated with intermaxillary traction using skeletal anchorage system. J Korean Assoc Oral Maxillofac Surg 2012. [DOI: 10.5125/jkaoms.2012.38.5.284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hye-Sun Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sang-Hoon Lee
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Taegyun Youn
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Gon Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
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Ogura I, Kaneda T, Mori S, Sakayanagi M, Kato M. Magnetic resonance characteristics of temporomandibular joint disc displacement in elderly patients. Dentomaxillofac Radiol 2011; 41:122-5. [PMID: 22116131 DOI: 10.1259/dmfr/1286942] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the MR characteristics of temporomandibular joint (TMJ) disc displacement in elderly patients. METHODS Of the MR images of 1660 TMJs in 847 patients with disc displacement who underwent MRI for suspected temporomandibular disorders, 301 TMJs in 154 patients aged over 50 years were studied as an elderly group. These MR images of the elderly group were compared with those of a control group (1359 TMJs in 693 patients aged under 51 years) concerning disc displacement with or without reduction, joint effusion and osteoarthrosis. RESULTS The incidence of disc displacement with osteoarthrosis was significantly different between the elderly (41.9%) and the control (19.8%) groups (p = 0.000). Logistic multivariate regression analysis demonstrated that the osteoarthrosis was a significant variable (odds ratio = 2.94, p = 0.000). CONCLUSIONS This study suggests that MR characteristics of TMJ disc displacement in elderly patients includes osteoarthrosis.
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Affiliation(s)
- I Ogura
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan.
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Zhao YP, Zhang ZY, Wu YT, Zhang WL, Ma XC. Investigation of the clinical and radiographic features of osteoarthrosis of the temporomandibular joints in adolescents and young adults. ACTA ACUST UNITED AC 2011; 111:e27-34. [PMID: 21237425 DOI: 10.1016/j.tripleo.2010.09.076] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/17/2010] [Accepted: 09/27/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the clinical and radiographic features of osteoarthrosis (OA) of the temporomandibular joints (TMJOA) in human adolescents and young adults. STUDY DESIGN Patients (n = 4883) with temporomandibular disorders (age, 11 to 30 years) underwent clinical and radiographic examinations. The radiographic findings were classified as erosive bony changes, proliferative changes mainly, including flattening with uneven sclerosis, and osteophytes of the condyle, and bilaterally short condylar processes. In addition, we interpreted the reassessment radiographs of 156 of the patients. RESULTS Seven hundred eleven patients had radiographic signs of OA. The frequency of OA was higher in women (563/3360, 16.8%) than in men (148/1523, 9.7%). Most patients (541/711, 76.1%) with signs of OA showed proliferative changes of OA. Moreover, 56.4% of patients with TMJOA (88/156) remained stable. CONCLUSIONS These results suggest that although OA is an age-related disease, aging is not the crucial factor in the pathogenesis of OA.
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Affiliation(s)
- Yan-ping Zhao
- Department of Oral Radiology and Center for TMD and Orofacial Pain, Peking University, School and Hospital of Stomatology, Beijing, China
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Size, shape and age-related changes of the mandibular condyle during childhood. Eur Radiol 2010; 20:2512-7. [DOI: 10.1007/s00330-010-1828-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/25/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
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Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, John MT, Schiffman EL. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. ACTA ACUST UNITED AC 2009; 107:844-60. [PMID: 19464658 DOI: 10.1016/j.tripleo.2009.02.023] [Citation(s) in RCA: 413] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 12/17/2008] [Accepted: 02/09/2009] [Indexed: 01/05/2023]
Abstract
OBJECTIVE As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT). STUDY DESIGN Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA). RESULTS For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA. CONCLUSION Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.
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Affiliation(s)
- Mansur Ahmad
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota 55455, USA.
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Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol 2009; 38:141-7. [PMID: 19225084 DOI: 10.1259/dmfr/59263880] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate and correlate with age the severity of temporomandibular joint (TMJ) osteoarthritic changes using cone beam CT (CBCT). METHODS The images of 71 patients with findings of degenerative arthritis were retrieved from the computer data base. All patients had been examined with CBCT (NewTom 9000 QR-DVT). Left and right TMJs were evaluated independently for each patient. TMJ evaluation included: (a) bony changes of the condyle (flattening, erosion, sclerosis, osteophytes, resorption); (b) joint space (normal, increased, reduced, bony contact between the condyle and the mandibular fossa); and (c) bony changes of mandibular fossa (normal, sclerosis, erosion, resorption). The radiographic findings were statistically analysed. RESULTS Significant differences in the mean age were found: (a) between absent and moderate erosion (P = 0.019), as well as between absent and extensive erosion (P = 0.048); (b) between absent and extensive formation of osteophyte (P = 0.003), as well as between slight and extensive formation of osteophyte (P = 0.025); (c) between normal joint space and bony contact (P = 0.0002), as well as between reduced joint space and bony contact (P = 0.001). CONCLUSIONS Degenerative arthritis is an age-related disease. The progression and severity of osseous changes in the condylar head and mandibular fossa are increased with age. In older age groups, patients are expected to have more frequent and severe progressive degenerative bony changes due to the development of TMJ osteoarthritis than patients in younger age groups.
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Affiliation(s)
- Ke Alexiou
- Department of Oral Diagnosis and Radiology, School of Dentistry, University of Athens, Greece
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Yamamoto A, Sano T, Otonari-Yamamoto M, Nishikawa K, Kwok E. A potential reference point for assessment of condylar bone marrow of the temporomandibular joint on proton density weighted images. Cranio 2008; 26:246-52. [PMID: 19004305 DOI: 10.1179/crn.2008.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The purpose of this research was to determine a potential reference point for measurement of signal intensity of bone marrow of the condyle on proton density-weighted images (PDW) prior to analysis of bone marrow abnormality related to symptomatic osteoarthritis of the temporomandibular joint (TMJ). The study was based on 79 joints in 41 patients. The regions of interest (ROI) were placed over the bone marrow of the condyle and four other structures, It was hypothesized that a correlation between signal intensity of ROI over bone marrow and that of another structure would provide a potential reference point4or measurement of signal intensity of bone marrow. A significant positive linear correlation was found in the group for gray matter-1 and bone marrow. The correlation coefficient was 0.3 (Pearson correlation coefficient; p < 0.05). It was determined that gray matter is a potential reference point in evaluating the signal intensity of bone marrow in the mandibular condyle.
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Affiliation(s)
- Aya Yamamoto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College 1-2-2, Masago, Mihama-ku, Chiba, 261-8502, Japan.
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Sano T, Yajima A, Otonari-Yamamoto M, Wakoh M, Katakura A. Interpretation of images and discrepancy between osteoarthritic findings and symptomatology in temporomandibular joint. JAPANESE DENTAL SCIENCE REVIEW 2008. [DOI: 10.1016/j.jdsr.2008.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle. Int J Oral Maxillofac Surg 2008; 37:529-34. [DOI: 10.1016/j.ijom.2008.02.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 01/17/2008] [Accepted: 02/29/2008] [Indexed: 11/19/2022]
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Yajima A, Sano T, Otonari-Yamamoto M, Otonari T, Ohkubo M, Harada T, Wakoh M. MR evidence of characteristics in symptomatic osteoarthritis of the temporomandibular joint: increased signal intensity ratio on proton density-weighted images of bone marrow in the mandibular condyle. Cranio 2007; 25:250-6. [PMID: 17983124 DOI: 10.1179/crn.2007.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The purpose of this study was to clarify the presence of pain and a correlation between pain and characteristics of signal intensity of mandibular bone marrow in temporomandibular joints (TMJ) with osteoarthritis (OA). A total of 196 joints in 98 patients with TMJ disorders were examined using magnetic resonance imaging (MRI). A pain score and signal intensity on mandibular bone marrow were analyzed in the TMJ with OA. TMJ with OA showed a higher degree of pain compared to those without (p < 0.05). During opening, the joints in the higher signal intensity group showed a significantly higher degree of pain compared to the joints in the lower signal intensity group in those with OA on proton density weighted images (p < 0.05). It was concluded that TMJ with osteoarthritis is related to pain and that a symptomatic osteoarthritic TMJ can accompany bone marrow changes in the condyle, showing an increased signal on proton density weighted images.
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Affiliation(s)
- Aya Yajima
- Dept. of Oral and Maxillofacial Radiology, Tokyo Dental College 1-2-2 Masago, Mihama-ku Chiba 261-8502, Japan.
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Wadhwa S, Embree M, Ameye L, Young MF. Mice deficient in biglycan and fibromodulin as a model for temporomandibular joint osteoarthritis. Cells Tissues Organs 2006; 181:136-43. [PMID: 16612079 DOI: 10.1159/000091375] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The temporomandibular joint (TMJ) within the craniofacial complex is unique. In humans, the TMJ can become diseased resulting in severe and disabling pain. There are no cures for TMJ disease at this time. Animal models of TMJ disease are scarce, but some exist, and they are described in this paper. We present in greater detail one animal model that is deficient in two extracellular matrix (ECM) proteoglycans, biglycan (BGN) and fibromodulin (FMOD). Doubly deficient BGN/FMOD mice develop premature TMJ osteoarthritis (OA). In order to explore the mechanistic basis of TMJ-OA, tissues from the condyle of mutant mice were examined for their relative capacity to differentiate and undergo apoptosis. Our data show that there is a redistribution of the critical ECM protein, type II collagen, in mutant mice compared with controls. Mutant mice also have increased apoptosis of the chondrocytes embedded in the articular cartilage. We speculate that the overall imbalance in apoptosis may be the cellular basis for the abnormal production of structural ECM proteins. The abnormal production of the ECM could, in turn, lead to premature erosion and degradation of the articular surface resulting in TMJ-OA. These data underscore the importance of the ECM in controlling the structural integrity of the TMJ.
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Affiliation(s)
- Sunil Wadhwa
- Craniofacial and Skeletal Diseases Branch, National Institutes of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
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Landes CA, Goral W, Mack MG, Sader R. 3-D sonography for diagnosis of osteoarthrosis and disk degeneration of the temporomandibular joint, compared with MRI. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:627-32. [PMID: 16677921 DOI: 10.1016/j.ultrasmedbio.2006.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 01/10/2006] [Accepted: 01/31/2006] [Indexed: 05/09/2023]
Abstract
This study determined the value of three-dimensional (3-D) sonography for the assessment of osteoarthrosis and disk degeneration of the temporomandibular joint (TMJ). Sixty-eight patients (136 TMJ) with clinical dysfunction were examined by 272 sonographic 3-D scans. An 8- to 12.5-MHz motor-angulated transducer positioned inferior-parallel to the zygomatic arch scanned the region-of-interest. 3-D condylar morphology was compared with subsequent magnetic resonance imaging (MRI). Fifty-three datasets were complete, i.e., 106 TMJ, 212 examinations. 3-D sonographic examination took 5 min and attained 70% sensitivity/76% specificity/75% accuracy; positive predictive value was 44%%; negative predictive value was 90%. Disk degeneration was diagnosed synonymously with 64%/73%/71%/42%/ 87%. 3-D sonography proved to be reliable for exclusion of osteoarthrosis as disk degeneration compared with MRI, whereas the presence of osteoarthrosis and disk dislocation cannot be reliably diagnosed. Prospective use will include routine screening, using more sophisticated equipment with higher frequency in real-time 3-D viewing.
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Affiliation(s)
- Constantin A Landes
- Department of Oral Maxillofacial and Plastic-Facial Surgery, Frankfurt University Medical Centre, Frankfurt, Germany.
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Takatsuka S, Yoshida K, Ueki K, Marukawa K, Nakagawa K, Yamamoto E. Disc and condyle translation in patients with temporomandibular disorder. ACTA ACUST UNITED AC 2005; 99:614-21. [PMID: 15829887 DOI: 10.1016/j.tripleo.2004.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate causal relationship between disc and condyle range of movement and clinical signs and symptoms in patients with temporomandibular disorders (TMD), using magnetic resonance imaging (MRI). STUDY DESIGN The subjects comprised of a study group of 191 patients with TMD and a control group of 43 asymptomatic patients. The clinical assessment consisted of range of maximum mouth opening (MMO) and preauricular pain during mandibular function. After clinical and radiographic findings assessment, disc and condyle condition were examined by MRI and the range of movement was accordingly classified. RESULTS Disc displacement was observed in 156/191 (81.7%) of the study group and 9/43 (20.9%) of the control group. When disc and condyle mobility was presented around the eminence, wider MMO range was maintained, P < .05. Presence of osteoarthrosis (OA) was not correlated with preauricular pain, because OA variables were mild in the study group. CONCLUSION Maintenance of disc/condyle translation is an important factor in TMJ function, irrespective of disc displacement or arthritis.
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Affiliation(s)
- Shigeyuki Takatsuka
- Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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Kurita H, Kojima Y, Nakatsuka A, Koike T, Kobayashi H, Kurashina K. Relationship between temporomandibular joint (TMJ)-related pain and morphological changes of the TMJ condyle in patients with temporomandibular disorders. Dentomaxillofac Radiol 2004; 33:329-33. [PMID: 15585811 DOI: 10.1259/dmfr/13269559] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to analyse the relationship between temporomandibular joint (TMJ)-related pain and morphological change of the TMJ condyle in patients with temporomandibular disorders. METHODS Data were obtained from 178 joints in 89 patients. The joints were clinically assessed for pain on mandibular function and on lateral palpation of the TMJ. They were also assessed for radiographic evidence of bone change at the articular surface (OAAS) and resorption of the lateral part of the condyle (RLC). RESULTS A higher prevalence of joint pain on function was observed in joints with OAAS than in those without OAAS (Chi-square test of independence, P < 0.05). Significant relationships were found between palpation pain and OAAS and between palpation pain and RLC (Chi-square test of independence, P < 0.05). In addition, patients with RLC showed a significantly lower pain threshold for external mechanical stimuli than those without RLC (Welch's t-test, P < 0.05). CONCLUSIONS These results suggest a possible relationship between pain on function and OAAS as well as a relationship between palpation pain and RLC. Pain on lateral palpation may be related to the pathological conditions that induce RLC.
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Affiliation(s)
- H Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
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Emshoff R, Rudisch A. Determining predictor variables for treatment outcomes of arthrocentesis and hydraulic distention of the temporomandibular joint. J Oral Maxillofac Surg 2004; 62:816-23. [PMID: 15218559 DOI: 10.1016/j.joms.2003.12.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the clinical variable of TMJ pain chronicity and the magnetic resonance (MR) imaging variable of osteoarthrosis (OA) may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ. PATIENTS AND METHODS The study consisted of 29 TMJ pain patients, who were assigned a unilateral clinical temporomandibular disorder (TMD) of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)," and a TMJ pain side-related MR imaging diagnosis of disc displacement without reduction. Bilateral sagittal and coronal MR images were obtained immediately preoperatively to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria of success were 1). an absence of signs and symptoms characteristic of a diagnosis of ID type III and/or 2). a reduction in pain level of 85% or greater. A multiple logistic regression analysis was used to compute the odds ratio for TMJ pain chronicity (duration >6 months and <2 years) and OA for successful outcomes versus nonsuccessful outcomes. RESULTS The pretreatment data revealed no significant relationship between the clinical disorder "TMJ pain associated with ID type III" and the MR imaging finding of OA (P =.103). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P =.000), a significant reduction in clinical diagnoses of TMDs (P =.000), and a significant increase in mandibular range of motion (P =.000). Significant increase in risk of a nonsuccessful outcome (pain reduction <85%) occurred with TMJ pain chronicity (odds ratio of 41.0) (P =.018). Significant increase in benefit of a successful outcome (absence of ID type III) occurred with TMJ OA (odds ratio 1:16.7, P =.06) (P =.044). CONCLUSIONS Arthrocentesis in chronic TMJ pain patients was less successful than in nonchronic patients with regard to treatment outcome of pain reduction. Arthrocentesis in patients with TMJ OA was more beneficial with regard to the disappearance of ID type III than in non-OA patients. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.
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Emshoff R, Rudisch A. Are internal derangement and osteoarthrosis linked to changes in clinical outcome measures of arthrocentesis of the temporomandibular joint? J Oral Maxillofac Surg 2003; 61:1162-7; discussion 1167-70. [PMID: 14586851 DOI: 10.1016/s0278-2391(03)00676-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) have been described as an effective modality in the treatment of patients with clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the magnetic resonance (MR) imaging variables of internal derangement (ID) and osteoarthrosis (OA) and the presence of capsulitis/synovitis (C/S) may be linked to changes in TMJ signs and symptoms associated with the performance of arthrocentesis and hydraulic distention. PATIENTS AND METHODS The study consisted of 27 TMJ pain patients, who were assigned a clinical unilateral TMJ diagnosis of ID type III (disc displacement without reduction). Bilateral sagittal and coronal MR images were obtained immediately preoperatively and at a 2-month follow-up to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. RESULTS The pretreatment data revealed a significant relationship between the clinical finding of TMJ pain and the MR imaging findings of ID (P <.001), ID type (P <.001), and OA (P <.05). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P <.001), a significant reduction in the clinical diagnoses of ID type III (P <.05), and a significant increase in mandibular range of motion (P <.05). There was no change in the prevalence rates of associated MR imaging diagnoses of TMJ ID and/or OA. CONCLUSION The study findings suggest that clinical pain is related to TMJ-related MR imaging findings of ID and OA. These diagnoses proved not to be linked to changes in therapeutic outcome measures of TMJ pain and mandibular range of motion.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillo-Facial Surgery, Innsbruck, Austria.
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Brandlmaier I, Bertram S, Rudisch A, Bodner G, Emshoff R. Temporomandibular joint osteoarthrosis diagnosed with high resolution ultrasonography versus magnetic resonance imaging: how reliable is high resolution ultrasonography? J Oral Rehabil 2003; 30:812-7. [PMID: 12880405 DOI: 10.1046/j.1365-2842.2003.01125.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to determine whether 12.5 MHz ultrasonography (US) could be used to assess the presence or absence of temporomandibular joint (TMJ) condylar osteoarthrosis. In 40 consecutive patients with TMJ disorders, 80 TMJs were investigated by US to analyse the condylar morphology. In order to compare the respective findings with those of a diagnostic method offering a high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. With US showing a sensitivity of 87%, and a specificity of 20%, the data revealed US to be sensitive in detecting the presence, but insufficient in detecting the absence of osteoarthrosis. In addition, with a positive predictive value of 88%, and a negative predictive value of 18%, the results indicate that US may be valuable in diagnosing the presence, but insufficient in diagnosing the absence of osteoarthrosis. In view of the fact that the 12.5 MHz US technique proved to be a valuable diagnostic aid for the detection and prediction of abnormal condylar morphology, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.
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Affiliation(s)
- I Brandlmaier
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Innsbruck, Austria
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Emshoff R, Rudisch A, Bösch R, Strobl H. Prognostic indicators of the outcome of arthrocentesis: a short-term follow-up study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 96:12-8. [PMID: 12847438 DOI: 10.1016/s1079-2104(03)00219-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Arthrocentesis of the temporomandibular joint (TMJ) is purported to be an effective modality in the treatment of patients with closed-lock symptoms. The purpose of this study was to determine whether the clinical findings of disk displacement without reduction associated with pain in the TMJ are related to the discovery of TMJ osteoarthrosis (OA) through the use of magnetic resonance (MR) imaging and whether the presence of OA affects the treatment outcome of patients who undergo arthrocentesis of the TMJ. STUDY DESIGN The study population consisted of 38 patients with TMJ pain who were assigned a clinical diagnosis of unilateral internal derangement (ID) of the TMJ, type III (disk displacement without reduction), in combination with capsulitis/synovitis (C/S) and an MR imaging diagnosis of disk displacement without reduction in the painful TMJ only. Before the patients underwent arthrocentesis, bilateral sagittal and coronal MR images were obtained to confirm the presence or absence of ID and OA. The preoperative and postoperative levels of TMJ function with respect to pain and mandibular range of motion were evaluated and compared. Multiple logistic regression analysis was used to compute the odds ratios for successful outcomes for OA (n = 24) versus unsuccessful outcomes for TMJs (n = 14). RESULTS The preoperative data revealed a significant relationship between the clinical diagnosis of TMJ ID type III with C/S and the discovery of OA on MR images (P =.048). At the 2-month follow-up, a clinical evaluation revealed a significant reduction in TMJ pain during function (P =.000); a significant reduction in the clinical diagnoses of ID type III (P =.000), and C/S (P =.000); and a significant increase in the mandibular range of motion (P =.000). The patients with successful outcomes were more likely to be associated with an MR imaging finding of OA than were the patients with unsuccessful outcomes. (10.4 odds ratio; P =.016). CONCLUSIONS Our preliminary findings suggest that the presence of OA revealed on MR images is related to clinical pain; furthermore, OA proved to be an important prognostic determinant of successful arthrocentesis.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Austria.
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Emshoff R, Brandlmaier I, Gerhard S, Strobl H, Bertram S, Rudisch A. Magnetic resonance imaging predictors of temporomandibular joint pain. J Am Dent Assoc 2003; 134:705-14. [PMID: 12839406 DOI: 10.14219/jada.archive.2003.0256] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors conducted a study to evaluate whether temporomandibular joint, or TMJ, disorder subgroups are related to magnetic resonance imaging, or MRI, diagnoses of TMJ internal derangement, or ID; osteoarthrosis, or OA; effusion; and bone marrow edema. METHODS The TMJ disorder group was composed of 118 subjects with TMJ pain who were assigned a clinical unilateral single diagnosis of a specific TMJ disorder. The control group consisted of 46 subjects who did not have TMJ pain. Sagittal and coronal magnetic resonance images were obtained to establish the prevalence of ID, OA, effusion and bone marrow edema. The authors used a multiple logistic regression analysis to compute the odds ratios, or OR, for MRI features for control subjects versus four groups of subjects who had TMJ pain: ID type I (n = 35), ID type III (n = 39), capsulitis/synovitis (n = 26) and degenerative joint disease, or DJD, (n = 18). RESULTS MRI diagnoses that did not contribute to the risk of TMJ pain included disk displacement, or DD, with reduction and effusion. Significant increases in the risk of experiencing TMJ pain occurred selectively with DD without reduction (OR = 10.2:1; P = .007) and bone marrow edema (OR = 15.6:1, P = .003) for the ID type III group and with DD without reduction (OR = 11.7:1, P = .054) for the DJD group. Subjects in the group with ID type I were less likely to be associated with an MRI finding of OA than were control subjects (OR = 1:5.6). CONCLUSIONS While the contribution of MRI variables to the TMJ pain subgroups was not zero, most of the variation in each TMJ pain population was not explained by MRI parameters. Thus, MRI diagnoses may not be considered the unique or dominant factor in defining TMJ disorder populations. CLINICAL IMPLICATIONS Therapy for subjects with TMJ based on the evaluation of concomitant morphological abnormalities, whether prophylactically or as treatment for TMJ disorders, may be unwarranted.
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Affiliation(s)
- Rüdiger Emshoff
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
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Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study. J Oral Rehabil 2003; 30:537-43. [PMID: 12752937 DOI: 10.1046/j.1365-2842.2003.01111.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate whether the magnetic resonance (MR) imaging variables of temporomandibular joint (TMJ) internal derangement, osteoarthrosis and/or effusion may predict the presence of pain in patients with a clinical disorder of an internal derangement type (ID)-III. The relationship between TMJ ID-III pain and TMJ internal derangement, osteoarthrosis and effusion was analysed in MR images of 84 TMJs in 42 patients with a clinical unilateral diagnosis of TMJ ID-III pain. Criteria for including a TMJ ID-III pain patient were report of orofacial pain referred to the TMJ, with the presence of unilateral TMJ pain during palpation, function and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis and effusion. Using chi-square analysis for pair-wise comparison, the data showed a significant relationship between the MR imaging findings of TMJ ID-III pain and those of internal derangement (P=0.01) and effusion (P=0.00). Of the MR imaging variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P=0.82) and effusion (P=0.08) dropped out as non-significant in the diagnostic TMJ pain group when compared with the TMJ non-pain group. The odds ratio that a TMJ with an internal derangement type of disk displacement without reduction might belong to the pain group was strong (2.7:1) and highly significant (P=0.00). Significant increases in risk of TMJ pain occurred with 'disk displacement without reduction in combination with osteoarthrosis' (5.2:1) (P=0.00) and/or 'disk displacement without reduction in combination with osteoarthrosis and effusion' (6.6:1) (P=0.00). The results suggest that TMJ pain is related to internal derangement, osteoarthrosis and effusion. However, the data re-emphasize the aspect that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain instances.
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Affiliation(s)
- R Emshoff
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, A-6020 Innsbruck, Austria.
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Brandlmaier I, Grüner S, Rudisch A, Bertram S, Emshoff R. Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup of degenerative joint disease. J Oral Rehabil 2003; 30:401-6. [PMID: 12631164 DOI: 10.1046/j.1365-2842.2003.01035.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) as compared with the magnetic resonance imaging (MRI) 'gold standard'. The TMJ DJD group comprised 48 joints in 24 consecutive patients who were assigned a clinical bilateral diagnosis of TMJ DJD. The TMJ non-DJD group consisted of 82 joints in 41 consecutive patients without a TMJ-related diagnosis of TMD. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of degenerative joint changes. An MRI diagnosis of osteoarthrosis (OA) was defined by the presence of flattening, subchondral sclerosis, surface irregularities, and erosion of the condyle or presence of condylar deformities associated with flattening, subchondral sclerosis, surface irregularities, erosion and osteophyte. For the CDC/TMD interpretations, the positive predictive of DJD for OA was 67%, and for the presence of degenerative joint changes 88%. The overall diagnostic agreement for DJD was 44.6% with a corresponding K-value of 0.01. Most of the disagreement was due to false-negative interpretations of asymptomatic joints. The results suggest CDC/TMD to be predictive for degenerative joint changes but insufficient for determination of OA. Patients assigned a clinical TMJ-related diagnosis of DJD may need to be supplemented by evidence from MRI to determine the presence or absence of OA.
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Affiliation(s)
- I Brandlmaier
- Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, A-6020 Innsbruck, Austria
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Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:437-45. [PMID: 12686927 DOI: 10.1067/moe.2003.95] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether common magnetic resonance (MR) imaging variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, effusion, and bone marrow edema are predictive of the presence of TMJ pain. STUDY DESIGN The relationship between TMJ pain and TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema was analyzed in MR images of 338 TMJs in 169 patients with a clinical diagnosis of TMJ pain and dysfunction. Criteria for including a patient with TMJ pain were a report of orofacial pain referred to the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, or unassisted or assisted mandibular opening. The criteria for including a patient with no pain were the absence of TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 129 patients with unilateral TMJ pain, 18 with bilateral TMJ pain, and 22 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema. Logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, effusion, and bone marrow edema for nonpainful TMJs (n = 173) versus painful TMJs (n = 165). RESULTS For pairwise comparison, the chi(2) test was used; the resultant data showed a significant relationship between the clinical findings of TMJ pain and the MR imaging diagnoses of internal derangement (P =.000), osteoarthrosis (P =.015), effusion (P =.002), and bone marrow edema (P =.016). Of the MR imaging variables considered simultaneously in multiple logistic regression analysis, osteoarthrosis (P =.405), effusion (P =.131), and bone marrow edema (P =.231) dropped out as nonsignificant in the diagnostic TMJ pain group in comparison with the TMJ no-pain group. Significant increases in risk of TMJ pain occurred with disk displacement without reduction in combination with osteoarthrosis and bone marrow edema (3.7:1 odds ratio; P =.000) and with disk displacement without reduction in combination with osteoarthrosis and effusion (2.8:1 odds ratio; P =.000). CONCLUSIONS The results suggest that TMJ pain is related to internal derangement, osteoarthrosis, effusion, and bone marrow edema. However, the data reemphasize that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain occurrence.
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Affiliation(s)
- Rüdiger Emshoff
- University of Innsbruck, Höhenstrae 5, A-6020 Innsbruck, Austria.
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