Examination Of Temporomandibular Joint Research Articles

Evolving Oral Diagnostics: Cone-beam Computed Tomography's (CBCT) Importance in Contemporary Dentistry

Recent improvements in cone-beam computed tomography (CBCT) have transformed maxillofacial imaging, which formerly depended on 2D imaging. This review highlights the benefits of CBCT in many dental specialties, including implant dentistry, endodontics, orthodontics, and temporomandibular joint examination. CBCT provides remarkable diagnostic accuracy while reducing radiation exposure, making it an invaluable tool in the dental practice. Artificial Intelligence and machine learning integration in CBCT technology offers numerous benefits, including automated image analysis, pathology detection, treatment planning, radiation dose reduction, image enhancement, workflow optimization, predictive analytics, personalized treatment plans, tele dentistry, and dental education. AI's role in dentistry is expected to improve diagnostic and therapeutic capacities while optimizing CBCT scans, resulting in better patient care.

ULTRASONOGRAPHY IN THE INVESTIGATION OF TEMPOROMANDIBULAR JOINTS: PROBLEMS AND PROSPECTS

Ultrasonography (USG) can be considered as a useful method for rapid screening of patients with suspected temporomandibular disorders (TMDs). It is necessary to select USG parameters of the temporomandibular joint (TMJ) and the masticatory muscles (MM) with unambiguous interpretation and to standardize them (determine the norm and reference points of measurement). Purpose of the study. To review the ultrasonographic parameters of the TMJ and masticatory muscles MM with unambiguous interpretation. Materials and methods. An analysis of the literature was carried out by processing scientific and metric bases, from which 26 articles were selected. Results. During the USG examination of the TMJ and MM, various parameters are determined, which can be conditionally divided into parameters with an unambiguous interpretation, and those that cause controversy. Based on the analysis of the scientific and practical literature, as well as our own experience, USG parameters with an unambiguous interpretation were selected, namely, the width of the joint space, the amplitude of condylar translation, the thickness of the MM at rest and during compression, the percentage of thickening of MM, the position of the articular disc when closed and open mouth, movement of the condyle during opening and closing the mouth, clarity and uniformity of the width of the subchondral-cartilaginous complex of the condyle. Conclusions. The literature review indicates an urgent need to standardize the USG protocol for TMJ and masticatory muscle examination by unifying clinically important USG parameters, determining their norm and gender characteristics.

Understanding the relationship between occlusal discrepancies and their role in temporomandibular disorder: A questionnaire-based research

Background: Temporomandibular disorder (TMD) presents as a multifaceted condition that impacts the temporomandibular joint (TMJ), the masticatory muscles, and other related structures. The role of occlusal factors in TMD etiology has been a subject of debate, necessitating further investigation. Aim: This questionnaire-based research aimed to explore the relationship between occlusal discrepancies and their role in TMD. Materials and Methods: The study involved 126 volunteers, comprising 69 females and 57 males, aged between 15 and 40 years, who had no previous history of systemic, musculoskeletal, or neurological disorders. To assess the degree of TMD, the researchers utilized the Fonseca questionnaire, and extra-oral and intra-oral examinations were done to check for occlusal discrepancy which was then classified according to the criteria of Angle’s classification in all three planes along with functional TMJ examination. Results: 55.5% of the population had some of the symptoms of TMJ disorders. Clinical examination showed that 45.2% of the population had tenderness on palpation. Variation of mouth opening was 37.72 ± 0.401 (±1.06%), the right lateral excursive movements were 6.88 ± 0.177 (±2.57%), and left lateral excursive movements were 6.6 ± 0.228 (±3.46%) respectively. The presence of “clicking” or “popping” was noted in 55 (43.6%) participants. Conclusion: The findings suggest that occlusal factors may significantly affect TMD development and symptomatology. Cases with occlusal discrepancies in multiple planes exhibited a significantly high prevalence of signs and symptoms related to TMD.

The relationship between the oblique sagittal temporomandibular joint disc position and the volume surface area of the condyle in young TMD adults.

The present study aims to compare the volume surface area of the condyle, the horizontal condylar axial angle and the disc-condyle angle between temporomandibular disorder (TMD) and asymptomatic volunteers, explore and analyze the relationship between the temporomandibular joint (TMJ) disc position in oblique sagittal plane and the volume surface area of the condyle in young adults with TMD symptoms. 84 young adult volunteers were received TMJ examination by Magnetic Resonance Imaging (MRI) and Cone Beam Computed Tomography (CBCT). TMD and asymptomatic volunteers were 42 each. MRI was used to assess the position of TMJ disc in the oblique sagittal plane with the condyle apex method. CBCT data were used for three-dimensional (3D) reconstruction of condyle and the measurements of the horizontal condylar axial angle and the volume surface area of the condyle. The condylar volume surface area of the TMD group was smaller than that of the asymptomatic group (p < 0.05), the disc condyle angle was larger than that of the asymptomatic group (p < 0.05), and no significant difference was found in the horizontal condylar axial angle (p > 0.05). In terms of correlation, the volume surface area of the condyle were negatively correlated with the position of the articular disc in TMD patients (p < 0.05). This significant negative correlation suggests that the possibility of disc displacement can be considered when poor condylar morphology is found.

Nutritional problems in rheumatoid arthritis patients with temporomandibular joint involvement

Rheumatoid arthritis (RA) is an inflammatory arthritis that affects synovial joints, and it is not surprising that the temporomandibular joint (TMJ), a synovial joint, is also affected. However, TMJ is rarely the first affected joint in the course of RA. Often, RA patients come to the physician with more focus on complaints in other peripheral joints. Therefore, asking TMJ complaints and symptoms, and TMJ examination in RA patients is often neglected by doctors too, because they focus more on other joints. This neglect may cause serious damage to the joints and cause disability. Examination of TMJs, which is a crucial component of vital activities such as nutrition and speech, should be added to the routine. Also, further studies may be focused on adding TMJ assessment to disease activity scales and health assessment questionnaires.

Nutritional problems in rheumatoid arthritis patients with temporomandibular joint involvement

Rheumatoid arthritis (RA) is an inflammatory arthritis that affects synovial joints, and it is not surprising that the temporomandibular joint (TMJ), a synovial joint, is also affected. However, TMJ is rarely the first affected joint in the course of RA. Often, RA patients come to the physician with more focus on complaints in other peripheral joints. Therefore, asking TMJ complaints and symptoms, and TMJ examination in RA patients is often neglected by doctors too, because they focus more on other joints. This neglect may cause serious damage to the joints and cause disability. Examination of TMJs, which is a crucial component of vital activities such as nutrition and speech, should be added to the routine. Also, further studies may be focused on adding TMJ assessment to disease activity scales and health assessment questionnaires.

Temporomandibular joint disorders in seronegative spondyloarthritis: what a rheumatologist needs to know?

Temporomandibular joint (TMJ) can be affected in the context of spondyloarthritis (SpA) with detrimental impact on individuals' quality of life. Intra-articular inflammation, synovitis, enthesitis, disc displacement and cervical vertebrae malalignment are some of the pathophysiological phenomena involved. Temporomandibular joint disorders (TMD) incidence appears to be higher in patients with ankylosing spondylitis and psoriatic arthritis, especially when clinical evaluation includes not only imaging but relevant history, TMJ examination and diagnostic criteria for TMD. The Visual Analogue Scale (VAS) pain score and Health Assessment Questionnaire Disability Index (HAQ) quality of life score could be useful tools. Panoramic radiographs and ultrasound can be used for screening but in symptomatic patients magnetic resonance imaging (MRI) is preferable. Conservative management and early pharmacological treatment can prevent permanent joint impairment. For refractory cases, early referral to Legislation for Oral and Maxillofacial Surgery (OMFS) specialists is indicated. The aim of this narrative review is to address the involvement of TMJ in SpA and to encourage clinicians to incorporate TMJ assessment in their physical examination and basic screening.

Five Steps for the Maintenance and Interception of Complications in Zygomatic Implants.

Zygomatic implants are used for the rehabilitation of the upper jaw of patients with severe and moderate bone atrophy. Possible post-surgical complications include soft tissue dehiscence, sinusitis, and prosthodontic fractures, and maintaining an accurate control is crucial. Additionally, zygomatic implants have a unique peri-implant anatomy, making traditional periodontal parameters unsuitable. The present paper aims to provide guidelines for the maintenance and interception of complications in patients rehabilitated with these kinds of implants. The proposed protocol includes: 1. intra/extraoral and temporo-mandibular joint examination; 2. soft tissue and transmucosal path observation with magnifiers; 3. peri-implant health indices and digital stimulation of tissues; 4. examination of prosthodontic devices; and 5. photographic recording. These steps facilitate the comprehensive evaluation and monitoring of clinical conditions of zygomatic-supported rehabilitations, including dehiscence and occlusal wear during follow-up appointments.

The use of intraoral ultrasound in the evaluation of the benign lesions in pediatric patients.

Ultrasonography (US) or diagnostic sonography is a radiographic technique that uses sound waves with frequencies higher than 20 kHz to demonstrate soft tissues such as muscles, internal organs, joints, and tendons. The US has various applications in dentistry such as cervical lymph node examination, salivary gland examination, periodontal examination, maxillofacial fracture examination, temporomandibular joint examination, and orofacial swelling examination. One of the most important advantages of the US is it does not produce any ionizing radiation. Since the US does not produce any ionizing radiation, it is a favorable technique especially for the patients who are susceptible to ionizing radiation such as pregnant patients and pediatric patients. In this article, we presented benign tumor lesions that were examined with the US in children and conducted a review of the literature.

Prevalence of Temporomandibular Joint Pain among Patients who Reported to Dental OPD at a Tertiary Hospital in Pondicherry, India: A Cross-sectional Study

Introduction: Temporomandibular Joint Disorder (TMJD) is a debilitating condition that affects the quality of a person’s life. However, its aetiology remains controversial. Understanding the signs and symptoms associated with this condition is crucial for better comprehension. Determining the prevalence of TMJD can emphasise the importance of routine Temporomandibular Joint (TMJ) examinations and the implementation of preventive measures. Aim: To determine the prevalence of TMJ pain among patients who reported to the dental Outpatient Department (OPD) between January 2015 and December 2019. Additionally, the study sought to identify potential predisposing factors for TMJ pain. Materials and Methods: A cross-sectional study was conducted in the Dental Department at Pondicherry Institute of Medical Sciences, Pondicherry, India. The study duration was six months, from December 2021 to May 2022. The study was done by examining the medical records of all patients who reported TMJ pain during the specified period. A total of 32,094 patients’ records were reviewed, and 322 patients reported pain in the TMJ region. The patients’ reported signs and symptoms were extracted from their case records and evaluated. Pearson’s Chi-square/Fisher’s-exact test was utilised to determine associations between the factors. Results: The mean age of the participants was 35.4±13.2 years. Out of the 32,094 patients who attended the dental OPD, 327 (1.02%; 95% CI: 0.91-1.13) reported TMJ pain. Among these patients, 207 (63.3%) were females. Joint sounds were the most common symptom, observed in 243 (74.3%) patients, followed by emotional stress or tension, reported by 205 (62.7%) patients. Most symptoms were more prevalent in females than males. Parafunctional habits and stress/tension showed a statistically significant association (p&lt;0.001) with male gender. Additionally, occlusal variation, joint sound, missing teeth, chewing with one side, parafunctional habits, and stress showed associations with age. Conclusion: The TMJ pain was more frequently reported by women than men in the studied population. The most common symptoms reported were pain and joint sounds. The highest number of patients fell within the 30 years-55 years age group. Although the prevalence identified was 1.02%, routine TMJ examination should be conducted as a standard part of oral and maxillofacial examinations to identify any predisposing factors that may lead to TMJD in the future.

Магнітно-резонансна томографія скронево-нижньощелепного суглоба

Resume. topresent the anatomy of the temporomandibular joint of healthy people based on the results of the magnetic resonance imaging. Methods: there were examined 47 patients without the pathology of the temporomandibular joint. Results. There is presented anatomy of the temporomandibular complex based on the results of magnetic resonance imaging in patients without the pathology of temporomandibular joint. There were compared two methods of temporomandibular joint examination: CT and MRI. There are presented indications and contraindications (absolute and relative) for MRI. Knowing the anatomy of the temporomandibular joint of a healthy person when performing magnetic resonance imaging one can prove the efficiency of the examination to diagnose temporomandibular joint diseases i.e. muscular and articular dysfunction, inflammatory and dystrophic diseases, posttraumatic injuries, ankyloses, etc. Conclusions. Using the magnetic resonance imaging makes it possible to effectively diagnose degenerative, inflammatory and neoplastic diseases of joints and surrounding soft tissues as it was proved by the performed examination of the temporomandibular joint of healthy people. Key words: temporomandibular joint, mandibular bone, maxillofacial area, magnetic resonance imaging.

Cone-Beam Computed Tomography for Temporomandibular Joint Imaging.

The temporomandibular joint (TMJ) can be viewed using various imaging techniques. Due to relatively low radiation doses and excellent spatial resolution, cone-beam computed tomography (CBCT) is being utilized more frequently in dental-maxillofacial imaging. For the diagnosis and treatment of TMJ disorders, an imaging examination is required. The osseous compartment is visualized using conventional CT, and CBCT and soft tissue imaging are extremely well appreciated on MRI. However, conventional TMJ imaging has its limitations due to its two-dimensional view and adjacent anatomical superimposition. TMJ imaging helps analyzethe cortical and the bony compartment's trabaculae and assessthe degree of skeletal abnormalities. TMJimaging protocols are also used to evaluate treatment responses. CBCT is the three-dimensional imaging of the bony compartment and joint space and the morphology of the bone visualized by removing superimposition and distortion. Compared to multislice CT, CBCT produces high-resolution multiplanar images with a reduced dose of radiation. The role of CBCT imaging in determining the normal bony anatomy and pathological changes is appropriately delineated in this paper. This work will focus on the use of CBCT for the examination of TMJ in various patientcategories, including those with osteoarthritis, remodeling, ankylosis, trauma, rheumatoid arthritis, synovial chondromatosis, and other intracapsular pathologies.

Awareness of temporomandibular joint involvement in rheumatoid arthritis patients by physicians dealing with rheumatology

The aim of this study is to evaluate the attitudes and awareness of physicians dealing with rheumatology about temporomandibular joint (TMJ) involvement while evaluating rheumatoid arthritis (RA) patients with the TMJ questionnaire we created. For this purpose, an online TMJ evaluation questionnaire consisting of 10 questions was prepared and completed by the physicians via the Google Forms application. Among those who participated in the survey; the percentage of correct answers to the question of whether the TMJ joint is a synovial joint was 95.5%. While the rate of those who correctly knew that more than half of the RA patients had TMJ involvement remained at 35.5%, the rate of those who correctly identified that RA rarely affected the first TMJ was 75.5%. The rate of those who knew that TMJ involvement is frequently bilateral in RA was 62.7%. The number of participants who answered the question of what the clinical findings are in TMJ involvement correctly was over 60%. When asked about radiological findings in TMJ involvement in RA, more than 75% of the participants expected joint space narrowing, erosion, and mandibular destruction. On the other hand, the number of physicians who expected radiological findings such as ostephitis and sclerosis as radiological findings was below 40%. While the number of physicians who performed TMJ inquiries and examinations in RA patients was only 15.5%, if there was a TMJ complaint, this rate increased to 80%. The number of participants using objective tests for the evaluation of TMJ was below 30%. Also, 85.5% of the participants ignored TMJ involvement in RA. In conclusion, our study showed that physicians dealing with rheumatology have low awareness of TMJ involvement in RA.

A clinical and MRI retrospective cohort study of patients with juvenile idiopathic arthritis (JIA) to determine if initial temporomandibular joint (TMJ) examination findings are associated with severity of TMJ arthritis

The purpose of the present study was to evaluate the association between initial TMJ examination findings and clinical and MRI severity of TMJ arthritis in a cohort of patients with JIA. The clinical variables were signs and symptoms at the initial TMJ evaluation. Outcome was the severity of TMJ arthritis as evaluated clinically by the Helkimo clinical dysfunction indices and by MRI. Associations of signs and symptoms with clinical and MRI severity were analyzed using a Fisher exact test and linear regression. The sample was composed of 101 patients with a mean age of 12.8 years, 76% of which were girls. Subjective difficulty in opening the mouth wide and objective limited MIO were the only clinical findings associated with both the severity of clinical dysfunction (p = 0.001 and p < 0.001, respectively) and the acute (p = 0.008 and p = 0.001, respectively) and chronic (p = 0.006 and p = 0.001, respectively) MRI severity of the TMJ arthritis. The results of this study suggest that in patients with JIA, limited mouth opening at the initial TMJ assessment may be a valid indicator of clinical severity of TMJ arthritis, which correlates with severity as seen on MRI.

Dosimetric evaluation for temporomandibular joint cone beam computed tomography exams using different field of view

Objectives. To optimize the absorbed organ dose in relation to the field of view for temporomandibular joint examinations in four cone beam computed tomography devices. Methods. An anthropomorphic adult head and neck phantom, and 192 LiF dosimeters (TLD-100) were used. The dosimeters were placed in the region corresponding to the lens, parotid glands, submandibular glands, and thyroid. Small, medium and large FOVs were selected on Orthopantomograph OP300 Maxio, PaX-i3D Smart, ORTHOPHOS XG, and i-CAT Next Generation device when it was possible. Results. A wide range of absorbed dose values was recorded for all organs due to the different exposure parameters of each device. The radiosensitive organ with the highest dose was the parotid glands. The devices with 5 × 5 cm FOV recorded a lower dose in this protocol, while for the device without a small FOV (≤5 × 5 cm), the lowest dose was observed with the large FOV (6 × 16 cm). Conclusions. We recommend a double exposure with an FOV of 5 × 5 cm in the OP300 Maxio, PaX-i3D Smart, and ORTHOPHOS XG device, while in the i-CAT Next Generation device, a single exposure FOV of 6 × 16 cm is indicated.

Prevalence of Sign and Symptoms of Temporomandibular Joint Disorders in Pakistani Population at Sheikhupura, Lahore: A Gender comparison

Background: Temporomandibular disorders have been considered as a common orofacial pain condition. The term temporomandibular pain dysfunction (TMPD) is used synonymously with myofacial pain dysfunction disorder/syndrome, temporomandibular disorder, craniomandibular disorder and many other terms. Objective: To evaluate the prevalence of signs and symptoms of temporo-mandibular joint disorder (TMD). Study Design: Descriptive cross-sectional study Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Faryal Dental College, Sheikhupura , Lahore, Pakistan from 1st February 2019 to 31st May 2021. Methodology: One hundred adolescents aged 15 to 60 years were enrolled. A detailed history about the chief complaint was taken and clinical examination was done. Temporomandibular joint examination performed included Auscultation for temporomandibular joint sounds like clicking and crepitus and palpation of both TMJs and associated muscles for evaluation of pain. Results: The most common signs of temporomandibular joint disorders were temporomandibular joint pain 78%, temporomandibular joint clicking 53% and trismus 29%. The most prevalent predisposing factors of temporomandibular joint disorders were parafunctional habits 40%, unknown factors 23% and history of road traffic accident/history of difficult extractions 9%. Male to female ratio showed female predominance (P = 0.001). Conclusion: Signs and symptoms of temporomandibular joint disorders were prevalent in Pakistani population with a clear female predominance. Key words: Temporomandibular disorders, Temporomandibular joint, Orofacial pain, Bruxism, Headache, Pain

Comparative Evaluation of Clinical Findings in Temporomandibular Joint Pathology with Magnetic Resonance Imaging – A Cross-sectional Study

Background: Temporomandibular disorders (TMDs) are broad group of clinical problems involving the masticatory musculature, the temporomandibular joint (TMJ), and the surrounding hard and soft-tissue components or combination of these problems. It can also be secondary to muscle hyperfunction or parafunction, traumatic injuries, hormonal influences, and articular changes within the joint. Magnetic resonance imaging (MRI) is currently considered as the preferred method for imaging the soft-tissue structures of the TMJ and has been pointed out as the best imaging modality in diagnosing disc displacements. Aim: The aim of this study is to comparatively evaluate the clinical findings of temporomandibular pathology with the MRI. Methodology: This is a cross-sectional observational study with comprised multiethnic group. A total of 50 patients reporting to the dental OPD with TMJ pathology were selected. These subjects underwent thorough clinical examination of TMJ and MRI of the TMJ was taken for all the individuals and parameters such as change in disk position, condylar surface, and effusion were recorded with the help of the radiologist. Statistical Data Analysis: Statistical presentation and analysis of the present study were done using the P value and Chi-square test by SPSSV20. Results: The results obtained in this study showed that out of 50 individuals, pain was present only in 28, that is, 56% of population other complaints of jaw deviation, clicking sound, and restricted mouth opening. Disc displacement was found only in 57.14% of symptomatic individual and 72.72% of asymptomatic individuals. MRI revealed pain and effusion was present only in 28% of symptomatic patients. About 76% of the subjects had jaw deviation while mouth opening out of which 68.42% showed disc displacement in MRI. About 56% of the subjects had positive history of trauma out of which 50% showed disc displacement in MRI. About 56% of the subjects reported with the clicking sound out of which 64.28% showed disc displacement in MRI. Conclusion: TMJ is one of the complex joints in the entire body. Because of this complexity of the TMJ, the pathologies as well as normal anatomical patterns must be known before any diagnosis. The selection of the proper radiological technique for TMJ, as well as of the patient, must be carefully made by the practitioner, in correlation with the clinical signs and symptoms. MRI is the diagnostic study of choice for evaluation of disk position and internal derangement of the joint. Although already many studies had been done on MRI, such type of studies should be conducted on large scale in future based on specific parameters for early diagnosis and treatment planning for patients suffering with TMD to provide quality treatment to the patients at initial stage.

Etiological Profile of Referred Otalgias in a Tertiary Care Hospital

Background and Objectives Otalgia (earache) is one of the commonest presenting complaints of the patients visiting ENT OPD and wide varieties of otological diseases are associated with it. Surrounding structural pathology of head and neck can at times manifest as otalgia (because of complex innervations of ear) known as referred otalgia. The term Referred Otalgia applied when the ear examination is normal, so it is important to search for the secondary cause in other structures like pharynx, larynx, teeth, TM, nose, sinuses, salivary glands, neck, and rarely thoracic structures like esophagus, bronchus and heart. &#x0D; Material and Methods: A prospective study was conducted in the department of ENT – HNS in Janaki Medial College Teaching Hospital from Janaury 01, 2019 to July 31, 2020 with ear pain only. All patients are subjected to full history and ENT examination, in addition to examination of Temporo-mandibular joint (TMJ) and neck. Some patients were sent for audiological and radiological assessment according to the finding in the examination and some had maxillofacial or orthopedic consultation. Data were analyzed, primary and referred otalgia was recorded. &#x0D; Results: Out of 607 patients with otalgia, 243(40%) had referred otalgia of this 39% were men and 61% were women. Commonest etiology of referred otalgia was dental causes followed by TMJ dysfunction. 3% patient had underlying malignancies. 37% had right earache, 42% had left earache and 21% had bilateral earache. &#x0D; Conclusion: A thorough clinical examination of surrounding structures particularly teeth and TMJ should be done as significant number of patient suffered from referred otalgia and while doing this malignancy should be kept in mind as etiology.

Evaluation of a low-dose protocol for cone beam computed tomography of the temporomandibular joint.

Objective:Evaluation of cone beam CT (CBCT) examination with a low-dose scanning protocol for assessment of the temporomandibular joint (TMJ).Methods:34 adult patients referred for CBCT imaging of the TMJ underwent two examinations with two scanning protocols, a manufacturer-recommended protocol (default) and a low-dose protocol where the tube current was reduced to 20% of the default protocol. Three image stacks were reconstructed: default protocol, low-dose protocol, and processed (using a noise reduction algorithm) low-dose protocol. Four radiologists evaluated the images. The Sign test was used to evaluate visibility of TMJ anatomic structures and image quality. Receiver operating characteristic analyzes were performed to assess the diagnostic accuracy. κ values were used to evaluate intraobserver agreement.Results:With the low-dose and processed protocols, visibility of the TMJ anatomical structures and overall image quality were comparable to the default protocol. No significant differences in radiographic findings were found for the two low-dose protocols compared to the default protocol. The area under the curves (Az) averaged for the low-dose and processed protocols, according to all observers, were 0.931 and 0.941, respectively. Intraobserver agreement was good to very good.Conclusion:For the CBCT unit used in this study, the low-dose CBCT protocol for TMJ examination was diagnostically comparable to the manufacturer-recommended protocol, but delivered a five times lower radiation dose. There is an urgent need to evaluate protocols for CBCT examinations of TMJ in order to optimize them for a radiation dose as low as diagnostically acceptable (the as low as diagnostically acceptable principle recommended by NCRP).

DYNAMIC FUNCTIONAL MAGNETIC RESONANCE IMAGING OF TEMPOROMANDIBALAR JOINT

The aim of the study was to compare the potential of fast pulse sequences and traditional static images for evaluation of temporomandibular joint (TMJ) biomechanics and to optimize the magnetic resonance imaging (MRI) protocol of TMJ by inclusion of dynamic scanning to improve the diagnosis of internal derangements. Material and methods. Dynamic MRI with HASTE and true-FISP pulse sequences was integrated into conventional MRI examination of TMJ in 16 symptomatic patients with pain, restricted motion and clicking in the joint. MRI was performed on superconductive 1.5 T scanner Magnetom Espree (Siemens, Germany). The presence of motion and susceptibility artifacts, range of mandible head motion and intrarticular disc location in different jaw positions were analyzed when comparing static and dynamic series. Results and discussion. HASTE was chosen for dynamic functional MRI of TMJ because it was less prone to susceptibility artifacts and provided better tissue contrast compared to true-FISP. Our initial experience has demonstrated dynamic scanning to be a time-efficient supplementary technique providing detailed information about TMJ biomechanics during active jaw movements at a high temporal resolution compared to traditional MRI examination. However, minimal anterior disc dislocation could be missed on dynamic series due to poor visualization of the posterior disc band on full closing. The further optimization of dynamic scanning technique on a large patients group using principles of the evidence-based medicine is needed. This would allow improving the diagnosis and assisting clinicians to optimize treatment strategy in a wide range of TMJ disorders.