Assessment of condylar changes in patients with temporomandibular joint pain using digital volumetric tomography

Indications and use of cone beam computed tomography in children and young individuals in a university-based dental hospital

BACKGROUND

The aim of this study was to evaluate the indications of cone beam computed tomography (CBCT) in children and young individuals in a university-based dental hospital and their association with age, gender and field of view.

METHODS

7131 CBCT scans, taken during 3-year period, were reviewed and a total of 649 pediatric patients (0-18 years) with complete request forms were included. Data related to gender, age, referring department, CBCT indications, field of view (FOV), region of interest (ROI), need for re-exposure and patients received more than one CBCT examination were recorded.

RESULTS

The mean age was 13.57 ± 3.52 years and "malocclusion and dentofacial anomaly" (28.7%) was the most common clinical indication. Facial trauma, dental trauma and supernumerary tooth in males; "malocclusion and dentofacial anomaly" and implant planning in females were recorded more frequently compared to other gender. Maxilla was the most frequently monitored ROI (35.1%) for patients. Small (≤ 10 cm) FOV was preferred in 58.1% of all patients. Large FOV was selected in the majority of patients who underwent CBCT scan for "malocclusion and dentofacial anomaly" (89.6%). The repeated scans constituted 2.3% of patients and 105 patients (16.2%) underwent multiple CBCT scans on different dates for mainly orthodontic follow-up.

CONCLUSIONS

The justification of CBCT scans was not fully compatible with current guidelines and mainly larger FOV was preferred. The number of CBCT examination in children and young individuals tends to increase.

TRIAL REGISTRATION NUMBER

Not applicable.

Degenerative bony changes in the temporal component of the temporomandibular joint - review of the literature

Temporomandibular joint (TMJ) changes are quite frequent in adults, but not all changes are degenerative. A high prevalence of bone alterations in the TMJs was reported by different research groups. Disturbed remodeling of bony articulating structures occurs because of overloading masticatory forces or because the mechanical loading in the area out-weighs the adaptive capacity of the TMJ structures. Although most of the degenerative TMJ alterations are identified at the level of the condylar process, a complete evaluation of the degenerative modifications encountered in the temporal TMJ region should not be forgotten as they are important for a comprehensive assessment and further management of the clinical situation. Several research groups have described osseous remodeling in the temporal component of the TMJ. Evidence is scarce for degenerative modifications at the level of the articular eminence and thickening of the roof of the glenoid fossa has been associated with osteoarthritis.

Analysis of three-dimensional imaging findings and clinical symptoms in patients with temporomandibular joint disorders

Background

The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms.

Methods

A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test.

Results

TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85).

Conclusions

CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.

Low-dose cone-beam computed tomography in simulated condylar erosion detection: a diagnostic accuracy study

OBJECTIVES

The purpose of the present study was to assess the diagnostic accuracy of low-dose cone-beam computed tomography (CBCT) in the detection of simulated mandibular condyle erosions.

METHODS

102 simulated erosions were performed on the condyles of eight dry human mandibles. Each mandible was subjected to four CBCT scan protocols: high-definition (HD), normal definition (NORM), ultra-low-dose high-definition (ULD-HD), and ultra-low-dose normal definition (ULD-NORM). All scans were analyzed by two observers. The inter-observer and intra-observer agreement as well as the agreement with the gold standard were assessed. The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of erosion detection were calculated.

RESULTS

A substantial to almost perfect agreement with the gold standard was found regarding the HD protocol and substantial agreement in NORM and ULD-HD protocols; however, moderate agreement was found regarding the ULD-NORM protocol. The sensitivity, specificity and accuracy values were highest for the HD protocol followed by the NORM and ULD-HD which showed comparable results; while, the ULD-NORM protocol showed the least values.

CONCLUSIONS

The studied ULD-HD CBCT protocol can be recommended for the detection of mandibular condylar erosions due to the reduced radiation dose; however, ULD-NORM is not advocated for similar clinical use.

Comparison of the Bony Changes of TMJ in Patients With and Without TMD Complaints Using CBCT

STATEMENT OF THE PROBLEM

Temporomandibular joint disorders (TMD) may show a poor correlation between their clinical findings and radiological characteristics.

PURPOSE

The aim of this study was to assess the osseous alterations of temporomandibular joint (TMJ) in symptomatic and asymptomatic subjects by employing cone beam computed tomography (CBCT) images.

MATERIALS AND METHOD

In this study, CBCT images of 120 temporomandibular joints in 30 patients with TMJ disorder and 30 age- and sex-matched individuals without TMJ complaints were evaluated. Osteoarticular derangements of the joint were assessed by two experienced examiners. Data was statistically analyzed with SPSS software using chi-square test (p <0.05).

RESULTS

Out of 120 CBCT images (60 in each group), at least one osseous change was observed in 90% and 86.7% joints in symptomatic and asymptomatic subjects, respectively. There were no significant differences between symptomatic and asymptomatic subjects regarding frequency of osteoarticular changes including flattening (73.3% vs. 75%), irregularity (36.7% vs. 48.3%), sclerosis (20% vs. 8.3%), cyst (3.3% vs. 3.3%), erosion (13.3% vs. 21.7%), hypoplasia (3.3% vs. 5%), ankylosis (1.7% vs. Zero), osteophyte (43.3% vs. 40%), decrease joint space (3.3% vs. 3.3%), and increase joint space (5% vs. 5%). (p> 0.05).

CONCLUSION

By employing CBCT as a modern diagnostic imaging tool, findings of this study revealed that the frequency of various temporomandibular joint alterations on CBCT images is comparable in patients with and without TMD complaints, suggesting that some people with TMJ structural damage may not display clinical manifestations. Moreover, CBCT imaging might not be necessary for TMD patients and more attention should be given to clinical examination.