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Rotolo RR, Aiyar A, Perillo L, Pedersen TK, Stoustrup P. Orthodontic and orthopedic management of dentofacial deformity from juvenile idiopathic arthritis: a systematic literature review. Eur J Orthod 2024; 46:cjae023. [PMID: 38860748 DOI: 10.1093/ejo/cjae023] [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] [Indexed: 06/12/2024]
Abstract
BACKGROUND An update on the knowledge regarding the orthopedic/orthodontic role in treating JIA-related dentofacial deformities is relevant. OBJECTIVES This systematic review aimed to assess the level of evidence regarding the management of dentofacial deformity from juvenile idiopathic arthritis (JIA) with orthodontics and/or dentofacial orthopedics. SEARCH METHODS The following databases were searched without time or language restrictions up to 31 January 2024 (Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature). SELECTION CRITERIA Inclusion criteria were studies dealing with JIA subjects receiving treatment with orthodontic and/or dentofacial orthopedic functional appliances. DATA COLLECTION AND ANALYSIS After the removal of duplicate studies, data extraction, and risk of bias assessment according to ROBINS-I guidelines were conducted. Data extraction was conducted by two independent authors. RESULTS The electronic database search identified 397 eligible articles after the removal of duplicates. Following the application of the pre-defined inclusion and exclusion criteria, 11 articles were left for inclusion. Two trials were associated with a severe risk of bias, four trials were at moderate risk of bias, and the other five presented a low risk of bias. Various research groups employed and documented the effects of different types of appliances and methodologies. The study heterogeneity did not allow for meta-analyses. In addition, a lack of uniformity in treatment objectives was observed across the included studies. After treatment with dentofacial orthopedics skeletal improvement was demonstrated in 10 studies, and a decrease in orofacial signs and symptoms was reported in 7 studies. CONCLUSIONS Across the available literature, there is minor evidence to suggest that dentofacial orthopedics may be beneficial in the management of dentofacial deformities from JIA. There is little evidence to suggest that it can reduce orofacial signs and symptoms in patients with JIA. Based on current evidence, it is not possible to outline clinical recommendations for specific aspects of orthopedic management in growing subjects with JIA-related dentofacial deformity. REGISTRATION PROSPERO (CRD42023390746).
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Affiliation(s)
- Rotolo Rossana Rotolo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Via De Crecchio n. 6, 80138 Naples, Italy
| | - Akila Aiyar
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, Building 1613, DK 8000 Aarhus, Denmark
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Via De Crecchio n. 6, 80138 Naples, Italy
| | - Thomas Klit Pedersen
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, Building 1613, DK 8000 Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Vennelyst Boulevard 9, Building 1613, DK 8000 Aarhus, Denmark
| | - Peter Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, Building 1613, DK 8000 Aarhus, Denmark
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Ju HM, Kim HW, Choi SY, Jeon HM, Jeong SH, Ahn YW, Ok SM. A Comparison of the Condyle and Articular Eminence in Asian Juvenile Idiopathic Osteoarthritis Patients with Unilateral and Bilateral TMJ Involvement: A Retrospective Case-Control Study. J Clin Med 2023; 12:5566. [PMID: 37685631 PMCID: PMC10489145 DOI: 10.3390/jcm12175566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
This study compared the condylar volume, length, and articular eminence (AE) characteristics of normal individuals to those with unilateral and bilateral juvenile idiopathic osteoarthritis (JOA). The 116 patients were divided into four groups: Control (n = 16), affected condyle of unilateral JOA (Aff-Uni) (n = 36), non-affected condyle of JOA (NonAff-uni) (n = 36), and bilateral JOA (Bilateral) (n = 28). The differences in condyle volume and length and AE were analyzed using ANOVA and Bonferroni post-hoc tests. The results showed that Bilateral had a significantly different condylar volume, especially in the condylar head (p < 0.01), specifically the middle, anterior, and medial parts (p < 0.05). Condylar length also differed among the groups, with differences observed between the control group and the other three groups, as well as between the bilateral group and the other three groups (p < 0.01). AE total volume differed between the control group and Aff-Uni. In the detailed comparison, Aff-Uni and NonAff-Uni were smaller than the control group in the posterior, lateral, and medial sections (p < 0.05). In conclusion, depending on the involvement of unilateral or bilateral JOA, there were differences in condylar volume and AE when compared to the normal control group. Therefore, a prognosis should be evaluated by distinguishing between patients with unilateral and bilateral JOA.
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Affiliation(s)
- Hye-Min Ju
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
| | - Hee-Won Kim
- Department of Oral Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan-si 50612, Republic of Korea; (H.-W.K.); (S.-Y.C.)
| | - Seo-Young Choi
- Department of Oral Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan-si 50612, Republic of Korea; (H.-W.K.); (S.-Y.C.)
| | - Hye-Mi Jeon
- Dental Clinic Center, Pusan National University Hospital, Busan 49241, Republic of Korea;
| | - Sung-Hee Jeong
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
| | - Yong-Woo Ahn
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
| | - Soo-Min Ok
- Department of Oral Medicine, School of Dentistry, Pusan National University, Dental and Life Science Institute, Yangsan-si 50612, Republic of Korea; (H.-M.J.); (S.-H.J.); (Y.-W.A.)
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Miranda-Viana M, Moreira GM, de Souza LM, Nejaim Y, Haiter-Neto F, Freitas DQ. Tridimensional assessment of the mandibular angle in patients with different skeletal patterns by cone-beam computed tomography scans: a retrospective study. BMC Oral Health 2023; 23:361. [PMID: 37271800 DOI: 10.1186/s12903-023-03074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/24/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Since the muscles of chewing are involved in the region of the mandibular angle, important structures in surgical and orthodontic procedures, to study its morphological aspects and the possible influence of different patterns of skeletal development would be of interest. Thus, this study aimed to assess the influence of patient characteristics - such as sex, skeletal malocclusion (Class I, Class II, and Class III) and facial type (brachycephalic, mesocephalic, and dolichocephalic) - on the width, height, thickness, and volume of the mandibular angle, using cone-beam computed tomography (CBCT) scans. METHODS CBCT scans were assessed - 144 men and 154 women, total of 298 - and classified according to skeletal patterns (skeletal malocclusions and facial types). Width, height, and thickness of the mandibular angle were measured using OnDemand 3D software. The volumetric measures of the mandibular angle were obtained using the ITK-SNAP software. Analysis of Variance (multiway ANOVA) with Tukey's post-hoc test compared the data, with a 5% significance level. RESULTS Among the factors studied, sex significantly influenced all the analyzed variables (height, width, thickness, and volume of the mandibular angle) (p < 0.05); in general, male individuals presented higher values than females. In some cases, the skeletal malocclusion and facial type factors influenced only the width and height variables (p < 0.05); in general, the Class III and dolichocephalic individuals presented higher values in relation to the other types of skeletal malocclusions and facial types. CONCLUSIONS Variations in the craniofacial growth pattern, considering the different skeletal malocclusions and facial types, had some influence in the width and height dimensions of the mandibular angle. Furthermore, sex influenced all the studied variables.
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Affiliation(s)
- Murilo Miranda-Viana
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil.
| | - Gabriel Mosso Moreira
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
| | - Larissa Moreira de Souza
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
| | - Yuri Nejaim
- Oral Radiology Area, Dental School, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, SP, 13414-903, Brazil
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Cavagnetto D, Abate A, Caprioglio A, Cressoni P, Maspero C. Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study. Prog Orthod 2021; 22:32. [PMID: 34595615 PMCID: PMC8484372 DOI: 10.1186/s40510-021-00380-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is currently no information on how different mandibular segments are affected by juvenile idiopathic arthritis. The aim of this paper is to assess volumetric differences of different mandibular segments in subjects with unilateral and bilateral JIA and to compare them with non-JIA control volumes. MATERIALS AND METHODS Forty subjects with unilateral TMJ involvement and 48 with bilateral TMJ involvement were selected for the case group and 45 subjects with no known rheumatic comorbidities for the control group. The mandible of each subject was divided according to a validated method into different paired volumes (hemimandible, condyle, ramus and hemibody). RESULTS The ANOVA test revealed a statistically significant difference in all the groups for condylar and ramus volumes, and the pairwise comparison evidenced a statistically significant higher condylar and ramus volume in the control group (1444.47 mm3; 5715.44 mm3) than in the affected side in the unilateral JIA group (929.46 mm3; 4776.31 mm3) and the bilateral JIA group (1068.54 mm3; 5715.44 mm3). Moreover, there was also a higher condylar volume in the unaffected side in the unilateral JIA group (1419.39 mm3; 5566.24 mm3) than in the bilateral JIA group and the affected side in the unilateral JIA group. CONCLUSIONS The affected side of unilateral JIA patients showed statistically significant lower volumes in the hemimandible, in the condyle and in the ramus. The largest total mandibular volume was observed in the control group, followed by the unilateral JIA group and, lastly, by the bilateral JIA group.
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Affiliation(s)
- Davide Cavagnetto
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy. .,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
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Abate A, Cavagnetto D, Rusconi FME, Cressoni P, Esposito L. Safety and Effects of the Rapid Maxillary Expander on Temporomandibular Joint in Subjects Affected by Juvenile Idiopathic Arthritis: A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2021; 8:33. [PMID: 33430404 PMCID: PMC7827492 DOI: 10.3390/children8010033] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/22/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Juvenile Idiopathic Arthritis (JIA) temporo-mandibular joints are often affected causing skeletal and dental malocclusions. The most frequent condition is mandibular hypoplasia, that may be associated with maxillary hypoplasia. The aim of this retrospective case control study is to investigate the effects and the safety of rapid maxillary expansion (RME) in growing patients affected by JIA. It was evaluated whether RME could be performed without complications on TMJs of JIA patients using DC/TMD protocol, and naso-maxillary transversal parameters were compared with the ones obtained on healthy patients. METHODS Twenty-five patients affected by JIA that ceased to manifest TMJ (Temporo-Mandibular Joint) symptoms in the previous year were treated with RME to solve the maxillary transverse hypoplasia. Postero-anterior cephalometric tracings were collected before and after treatment; linear measurements were obtained to study maxillary and nasal cavity modifications. Data were compared to those of a similar group of twenty-five healthy patients. Paired t-test and Independent t-test were used to evaluate changes before and after treatment in each group and to perform a comparison between the groups. RESULTS All patients demonstrated a statistically significant increase in nasal cavity width, maxillary width and upper and lower intermolar width. No patients presented a worsening of their TMJs condition. Intragroup comparisons revealed significant changes of cephalometric measurements, but no difference was found when comparing JIA and healthy patients. CONCLUSIONS Growing patients with JIA that ceased to show signs of active TMJ involvement for at least one year could be safely treated with RME, expecting similar benefits to those of healthy patients. Dentists and rheumatologists should be informed of safety and potential benefits of palatal expansion in JIA patients in order to improve the outcome of orthodontic treatment and reduce the indication for more invasive procedures (i.e., Surgical Assisted Rapid Maxillary Expansion).
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Affiliation(s)
- Andrea Abate
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Davide Cavagnetto
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Francesca Maria Emilia Rusconi
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Luca Esposito
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (A.A.); (D.C.); (F.M.E.R.); (P.C.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
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Exposto CR, Stoustrup P, Kristensen KD, Dalstra M, Pedersen TK. Condylar changes in patients with idiopathic condylar resorption: retrospective 2-year follow-up CBCT-based case-control study. Eur J Orthod 2020; 42:619-625. [PMID: 32036384 DOI: 10.1093/ejo/cjz099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVES To compare condylar development and changes in condylar radiological appearance in patients with idiopathic condylar resorption (ICR) to a healthy, age- and gender matched, control group. MATERIALS AND METHODS This case-control study included 16 ICR patients [mean age: 15years, 9 months; standard deviation (SD): 4 years) and 16 controls (mean age: 16 years, 8 months; SD: 4 years, 7 months), with diagnostic (T0) and 2-year follow-up (T1) CBCT examinations. Condylar changes were evaluated through changes in condylar neck angle (CNA), and the transversal, vertical and anteroposterior displacement of five condylar points between T0 and T1. The magnitude and direction of condylar changes were evaluated using vector analyses. A qualitative radiological evaluation of the TMJ was performed based on healthy, erosive and repaired morphological appearance. Linear and angular measurements were assessed using ANOVA and a Tukey post-hoc test, and vectors were tested using an independent-sample 2-tailed t-test. Fisher's exact test was used for the qualitative evaluation. RESULTS At T0, ICR patients exhibited decreased condylar height, smaller condylar width and posteriorly inclined CNA compared with the control group (P < 0.05). During observation, condylar vertical growth was smaller in the ICR group than in the control group (P < 0.05). Vector analysis showed an upward direction of vertical displacement for all condylar points in the control group; the ICR group showed a downward direction (P < 0.003). The radiological appearance of 75% of the ICR condyles and 94% of the control condyles did not change during the 2-year follow-up period. CONCLUSIONS ICR condyles displayed reduced vertical development compared with control condyles. The radiological appearance remained unchanged for most joints. Observed changes in radiological appearance did not always follow a progressive model of degenerative joint disease.
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Affiliation(s)
- Cristina R Exposto
- Section of Orthodontics, Department of Dentistry, Health, Aarhus University
| | - Peter Stoustrup
- Section of Orthodontics, Department of Dentistry, Health, Aarhus University
| | | | - Michel Dalstra
- Section of Orthodontics, Department of Dentistry, Health, Aarhus University
| | - Thomas K Pedersen
- Section of Orthodontics, Department of Dentistry, Health, Aarhus University
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
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Comparing Clinical and Radiological Manifestations of Adolescent Idiopathic Condylar Resorption and Juvenile Idiopathic Arthritis in the Temporomandibular Joint. J Oral Maxillofac Surg 2020; 79:774-785. [PMID: 33217307 DOI: 10.1016/j.joms.2020.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE This cross-sectional study compared orofacial manifestations at the time of diagnosis in 2 temporomandibular joint (TMJ) conditions: adolescent idiopathic condylar resorption (ICR) and TMJ involvement from juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS This retrospective study included 19 JIAs, 19 ICRs, and 19 control patients, all treated at the Section of Orthodontics, Aarhus University Craniofacial Clinic, Denmark. From patient files, we retrieved radiological data from cone-beam computed tomographies along with information on symptoms and orofacial function at the time of diagnosis. Validated methodologies were used to evaluate TMJ and dentofacial morphology. RESULTS We found no statistically significant intergroup differences in severity of deformation of TMJ structures (TMJ deformity) between JIA and ICR patients. However, the ICR group showed significantly greater signs of dentofacial deformity on 4 outcome variables: mandibular inclination, posterior/anterior lower face height ratio, mandibular sagittal position, and mandibular occlusal plane inclination. Significant intergroup differences in clinical presentation were seen in 5 of 20 variables. Thus, the JIA group reported significantly more symptoms of TMJ pain, TMJ morning stiffness, and TMJ pain on palpation during the clinical examination, whereas the ICR group reported significantly more TMJ clicking during function and had a higher proportion of patients with anterior open bite. CONCLUSIONS Cone-beam computed tomography examination showed a similar degree of TMJ deformity in ICR and JIA patients at the time of diagnosis. ICR patients presented with a significantly higher degree of dentofacial deformity than JIA patients and healthy controls, which relates to the timing of the diagnosis. Arthralgia, TMJ morning stiffness, and TMJ palpitation pain were more common in JIA patients, whereas TMJ clicking during function and anterior open bites were more common in ICR patients.
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Maspero C, Cavagnetto D, Abate A, Cressoni P, Farronato M. Effects on the Facial Growth of Rapid Palatal Expansion in Growing Patients Affected by Juvenile Idiopathic Arthritis with Monolateral Involvement of the Temporomandibular Joints: A Case-Control Study on Posteroanterior and Lateral Cephalograms. J Clin Med 2020; 9:E1159. [PMID: 32325675 PMCID: PMC7230922 DOI: 10.3390/jcm9041159] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) affecting temporomandibular joints (TMJ) in growing patients results in maxillofacial deformities, especially if only one condyle has been affected by the rheumatic disease. Mandibular hypoplasia is the most common issue and it may be associated with maxillary hypoplasia. The aim of this retrospective case-control study is to evaluate the effects of rapid maxillary expansion (RME) in these patients. METHODS 25 growing patients affected by maxillary hypoplasia, currently in a quiescent phase of JIA for at least one year and monolateral involvement of the TMJs, were treated with RME. Data gathered from posteroanterior and lateral cephalograms before and after 1 year from RME were compared to those of 25 non-JIA controls. RESULTS Nasal cavity width, maxillary width and upper and lower intermolar width statistically increased. Maxillary and mandibular symmetry indexes presented a statistically significant increase, so did the skeletal class. No signs or symptoms of TMJ activity of JIA occurred according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) criteria. No difference was found when comparing JIA and non-JIA patients apart from the better improvement of several mandibular symmetry indexes in the affected TMJ side of JIA patients. This event is allegedly due to a worse baseline asymmetry in JIA patients that underwent a bigger relative improvement after treatment. CONCLUSIONS Results suggest that solving maxillary hypoplasia and, therefore, premature contacts are likely to have allowed mandibular repositioning and condylar growth. RME is a safe and effective solution that can substantially improve maxillary and mandibular symmetry in growing patients affected by JIA with TMJ involvement.
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Affiliation(s)
- Cinzia Maspero
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (D.C.); (A.A.); (P.C.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Davide Cavagnetto
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (D.C.); (A.A.); (P.C.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Andrea Abate
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (D.C.); (A.A.); (P.C.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (D.C.); (A.A.); (P.C.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Marco Farronato
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; (D.C.); (A.A.); (P.C.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
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Assessment of condylar volume and ramus height in JIA patients with unilateral and bilateral TMJ involvement: retrospective case-control study. Clin Oral Investig 2019; 24:2635-2643. [PMID: 31760476 DOI: 10.1007/s00784-019-03122-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objectives of the study are to analyze volumetric differences of condylar volumes in patients with unilateral and bilateral JIA and to compare results with control condylar volumes. MATERIALS AND METHODS Forty-six CBCT images were analyzed for all patients affected by JIA, 37 females and 9 males (mean age 10.8 ± 4.2) with TMJ involvement (19 unilaterally, mean age 10.9 ± 4.5; 27 bilaterally, mean age 10.7 ± 4.5), and 25 CBCT of subjects without diagnosis of JIA were selected as controls (mean age 10.8 ± 4.2 years). In the case of unilateral JIA, condylar volumes and ramus lengths were compared with healthy condyle and with the compromised one. In the case of bilateral JIA, condyle volume and ramus lengths were compared with healthy one. The Shapiro-Wilk test was used to assess whether the data was normally distributed. Paired t test was applied to compare affected and non-affected condyle in the same patients (P < 0.05). Independent t test was used to evaluate whether the difference between the groups were comparable or significantly different (P < 0.05). RESULTS For the unilateral JIA group, significant differences comparing affected and non-affected condyles were found. A statistically significant reduction of the volume of the head, neck, and ramus was found in the affected side (P < 0.01). For the bilateral JIA group, statistically significant differences have been found considering the condylar head and neck, the whole condylar volume, and the ramus length compared with the control group (P < 0.05). CONCLUSIONS Subjects with unilateral JIA have condyles volumetrically smaller than those of the unaffected side and those found in healthy patients. A considerable decrease of the volume of all the anatomical structures considered in the patients with bilateral JIA was found compared with control group. CLINICAL RELEVANCE The study presents the effects of JIA on different anatomical structures highlighting their dimensional changes, whose sequelae are irreversible if not diagnosed and treated early.
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Stoustrup P, Pedersen TK, Nørholt SE, Resnick CM, Abramowicz S. Interdisciplinary Management of Dentofacial Deformity in Juvenile Idiopathic Arthritis. Oral Maxillofac Surg Clin North Am 2019; 32:117-134. [PMID: 31699581 DOI: 10.1016/j.coms.2019.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Temporomandibular joint (TMJ) arthritis impacts mandibular growth and development. This can result in skeletal deformity, such as facial asymmetry and/or malocclusion asymmetry. This article reviews the unique properties of TMJ and dentofacial growth and development in the setting of juvenile idiopathic arthritis (JIA). Specific orthopedic/orthodontic and surgical management of children with JIA and TMJ arthritis is discussed. The importance of interdisciplinary collaboration is highlighted.
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Affiliation(s)
- Peter Stoustrup
- Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus C, Denmark
| | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus C, Denmark; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark; Section of Oral Maxillofacial Surgery, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus, Denmark
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 longwood Avenue, Boston, MA 02115, USA; Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA
| | - Shelly Abramowicz
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory University, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA 30322, USA.
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11
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Mendoza LV, Bellot-Arcís C, Montiel-Company JM, García-Sanz V, Almerich-Silla JM, Paredes-Gallardo V. Linear and Volumetric Mandibular Asymmetries in Adult Patients With Different Skeletal Classes and Vertical Patterns: A Cone-Beam Computed Tomography Study. Sci Rep 2018; 8:12319. [PMID: 30120301 PMCID: PMC6098024 DOI: 10.1038/s41598-018-30270-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022] Open
Abstract
This study aimed to quantify the height of the mandibular condyle and ramus, condylar volume, and the asymmetry index in adult patients of different sex, skeletal class and vertical pattern using Cone-Beam Computed Tomography (CBCT), and to determine whether there were differences between these groups. The study used CBCT scans of 159 patients with a mean age of 32.32 ± 8.31 years. InVivoDental® software was used to perform both linear (condylar, ramal, and total height) and condylar volume measurements. Linear and volumetric asymmetries were calculated. There were not significant differences between right and left sides. The mean value obtained for condyle height was 7.27 mm, ramus height 42.3 mm, total height 49.6 mm and condyle volume 1907.1 mm3, with significant differences between men and women. Significantly higher values were found for condylar volume in hypodivergent patterns (p = 0.001) and for the asymmetry index of the condylar volume in Class II patients (p < 0.05). The prevalence of relevant asymmetry was high for condyle height and volume (73.1% y 75.6% respectively). Higher height and volume values were found among men, Class III, and hypodivergent patients. Linear and volumetric asymmetries were more prevalent among men, Class III and hyperdivergent patterns.
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Affiliation(s)
- Luz Victoria Mendoza
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Carlos Bellot-Arcís
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José María Montiel-Company
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
| | - Verónica García-Sanz
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José Manuel Almerich-Silla
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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12
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Ferri J, Potier J, Maes JM, Rakotomalala H, Lauwers L, Cotelle M, Nicot R. Les arthrites de l’articulation temporomandibulaire : mise au point et attitude pratique en ODMF et ODF. Int Orthod 2018; 16:545-561. [PMID: 30017771 DOI: 10.1016/j.ortho.2018.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Joël Ferri
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France; Université de Lille, U1008, médicaments et biomatériaux à liberation contrôlée, 59000 Lille, France; Association internationale de médecine orale et maxillofaciale (AIMOM), 7 bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France.
| | - Julien Potier
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Jean-Michel Maes
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Hervey Rakotomalala
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Ludovic Lauwers
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France; Association internationale de médecine orale et maxillofaciale (AIMOM), 7 bis, rue de la Créativité, 59650 Villeneuve-d'Ascq, France
| | - Mickael Cotelle
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
| | - Romain Nicot
- Département universitaire de chirurgie maxillofaciale et stomatologie, hôpital Roger-Salengro, CHU de Lille, boulevard du Prof.-Émile-Laine, 59037 Lille cedex, France
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13
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Abstract
Rheumatic diseases (RD) of the temporomandibular joints (TMJs) are increasingly frequent affections and unfortunately often confused with "classic" manducatory dysfunctions (disk dislocation, myofascial pain syndroms). Their diagnosis is mandatory, given the major subsequent craniofacial disorders, which may occur (mandibular condylar hypoplasia, facial hyperdivergence, remodelling of the condylar unit, ankylosis), although the clinical implementation remains unspecific. The delayed diagnosis may be explained by the embryologic, anatomical and physiological characteristics of this joint. Magnetic resonance imaging (MRI), scans and more recently cone-beam computed tomography (CBCT) allow to diagnose its early signs (alteration of the disc-ligament complex, intra-articular effusion, osteochondral lesions). The treatment of TMJ rheumatic diseases (RD) is not consensual, and often includes a non surgical phase (hygiene and dietary rules, non-steroid anti-inflammatory drugs (NSAI), occlusal splints, and/or a surgical phase for the advanced stages (joint washing, orthognathic surgery, or joint surgery), and non responding patients to the medical treatment of inflammatory rheumatism. Orthodontics will be useful to correct dento-alveolar compensations, while monitoring, however, the impact on joint function.
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14
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Miller E, Inarejos Clemente EJ, Tzaribachev N, Guleria S, Tolend M, Meyers AB, von Kalle T, Stimec J, Koos B, Appenzeller S, Arvidsson LZ, Kirkhus E, Doria AS, Kellenberger CJ, Larheim TA. Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol. Pediatr Radiol 2018; 48:792-800. [PMID: 29766249 DOI: 10.1007/s00247-017-4005-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Abstract
Inflammation and damage in the temporomandibular joint (TMJ) often develop without clinical symptoms but can lead to severe facial growth abnormalities and impaired health-related quality of life, making early diagnosis of TMJ changes crucial to identify. Inflammatory and osteochondral changes detectable through magnetic resonance imaging (MRI) occur in TMJs of approximately 40% of children with juvenile idiopathic arthritis (JIA), and no other imaging modality or physical method of examination can reliably detect these changes. Therefore contrast-enhanced MRI is the diagnostic standard for diagnosis and interval monitoring of JIA. However the specific usage of MRI for TMJ arthritis is not standardized at present. There is a recognized need for a consensus effort toward standardization of an imaging protocol with required and optional sequences to improve detection of pathological changes and shorten study time. Such a consensus imaging protocol is important for providing maximum information with minimally necessary sequences in a way that allows inter-site comparison of results of clinical trials and improved clinical management. In this paper we describe the challenges of TMJ imaging and present expert-panel consensus suggestions for a standardized TMJ MRI protocol.
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Affiliation(s)
- Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | | | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 08.9840-L4, Toronto, ON, M5G 1A4, Canada.
| | - Arthur B Meyers
- Department of Radiology, Nemours Children's Health System, Orlando, FL, USA
| | - Thekla von Kalle
- Department of Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany
| | | | - Linda Z Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Eva Kirkhus
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Tore A Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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15
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Stoustrup P, Iversen CK, Kristensen KD, Resnick CM, Verna C, Nørholt SE, Abramowicz S, Küseler A, Cattaneo PM, Herlin T, Pedersen TK. Assessment of dentofacial growth deviation in juvenile idiopathic arthritis: Reliability and validity of three-dimensional morphometric measures. PLoS One 2018. [PMID: 29534095 PMCID: PMC5849319 DOI: 10.1371/journal.pone.0194177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Patients with juvenile idiopathic arthritis (JIA) and involvement of the temporomandibular joint (TMJ) often experience abnormal facial growth. Three-dimensional (3D) assessment of dentofacial growth deviation has become more common with advancement and commercialization of imaging technologies. However, no standardized guidelines exist for interpretation of 3D imaging in patients with JIA. The aim of this study was to propose and validate morphometric measures for the 3D radiographic assessment of dentofacial growth deviation in patients with JIA to enhance: 1) Description of dentofacial growth deviation; 2) Treatment planning; 3) Longitudinal follow-up. Methods The study was conducted in a standardized sequential-phased approach involving: 1) Preliminary decision-making; 2) Item generation; 3) Test of content-validity; 4) Test of reliability; 5) Test of construct validity; 6) Establishment of final recommendations. Results Twenty-one morphometric measures were evaluated. Based on results of reliability and validity-testing including subjects with JIA (n = 70) and non-JIA controls (n = 19), seven measures received a “high recommendation” score. Those measures were associated with posterior mandibular height, occlusal cant, mandibular asymmetry, mandibular inclination, and anterior/posterior lower face height. Nine other measures were “moderately recommended” and five received a “somewhat recommendation” score. Conclusion Seven morphometric measures were considered very useful in the 3D assessment of growth deviation in patients with TMJ disease associated with JIA. These variables can be used to standardize the description of dentofacial deformities and to plan corrective interventions.
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Affiliation(s)
- Peter Stoustrup
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | - Kasper Dahl Kristensen
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Section of Orthodontics, University of Bergen, Bergen, Norway
| | - Cory M. Resnick
- Harvard School of Dental Medicine, Boston, MA, United States of America
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, United States of America
| | - Carlalberta Verna
- Clinic for Orthodontics and Pediatric Dentistry, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
- Section of Oral Maxillofacial Surgery, Aarhus University, Aarhus, Denmark
| | - Shelly Abramowicz
- Oral and Maxillofacial Surgery and Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
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16
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Kovalko I, Stoustrup P, Twilt M. Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: Challenges in Diagnosis, Treatment, and Outcomes. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0086-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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