TMJ Radiographs Research Articles

Osteoarthritis of the temporomandibularjoint

Osteoarthritis (OA) is a degenerativejoint disease marked by progressive lossof articular cartilage and damage of bony components. The clinical features include;joint pain, crepitus and limitation of movement. The exact cause of OA is unknownhowever some authors consider it as a multifaetorial disease. The age and over usageare the most common tactors, in addition to race and sex. ln case oftemporomandibular joint(TMJ), traumatic occlusion, and over load caused byparafunctions are additional factors. The purpose ofthis investigation was to study theTMJ) arthropathy among a group of Iraqi patients previously diagnosed as having(.OAOne hundred patients with OA are used in this study. They were examined.clinically and radiographically for effects of systemic OA on TMJResults of the study revealed that 39% of patients with OA have TMJ lesions ofdifferent degrees ranged between osteophytes, diminusion of joint space and bone.distruction ofglenoid fossa and head of condyleDental management of temporomandibular joints affected with OA usuallyaim to suppress the active disease, preserve functions, prevent deformity and relievepain. Early detection of the disease and early commencement of management greatly ireduce joint destruction and improve prognosis. Results of this study indicated thatl1% of patients had only TMJ lesions, with no other joints lesions. Because ofdifficulty of interpretation of TMJ radiographs we suggest criteria for radiographicdiagnosis of osteoarthritis ofthe TMJ

Clinical and radiological outcome of arthrocentesis followed by autologous blood injection for treatment of chronic recurrent temporomandibular joint dislocation.

BackgroundThis study was conducted to evaluate the functional outcome and MRI findings of arthrocentsis followed by autologous blood injection (ABI) into the joint space for management of chronic recurrent TMJ dislocation.Material and MethodsTotal ten patients with bilateral chronic recurrent condylar dislocation were included in the study. Arthrocentesis of both TMJ was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included; thorough history, clinical examination of TMJ, maximal mouth opening, frequency of dislocation, TMJ radiographs (open and closed mouth position), MRI, recurrence and presence of facial nerve paralysis.ResultsAt the end of 3 months follow-up 8 patients (80%) had successful outcome with no further episodes of dislocation, whereas two patients reported with recurrence. Post-operative MRI showed significant improvement after ABI, compared to pre-operative MRI. There were no degenerative changes to the bony and soft tissue components of TMJ.ConclusionsABI is a simple, safe, minimally invasive and cost-effective technique for treatment of chronic recurrent TMJ dislocation. MRI evaluation showed an improvement in the anatomical and spatial relationship of the osseous and soft tissue components of the TMJ. Key words:TMJ lavage, luxation, fibrosis, magnetic resonance imaging.

Excellence in publishing: the Wuehrmann prize

The American Academy of Oral and Maxillofacial Radiology (AAOMR) established “The Wuehrmann Prize” for the best radiology journal article of the year in 1995. The Award is named after Dr. Arthur H. Wuehrmann, a Distinguished Life Member of the Academy. Since then, eight published articles have been selected. The purpose of the award is to recognize excellence in publishing, which happens to be the motto of our publisher, Mosby Inc. The winning papers have been: White SC, Sapp JP, Seto BG, Mankovich NJ. Absence of radiometric differentiation between periapical cysts and granulomas. OOOOE 1994;78:650-4. Callender KI, Brooks SL. Usefullness of tomography in the evaluation of patients with temporomandibular joint disorders: a retrospective study. OOOOE 1996;81(6):710-9. Brooks SL, Brand JW, Gibbs SJ, Hollander L, Lurie AG, Omnell KA, Westessen PL, White SC. Imaging of the temporomandular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology. OOOOE 1997;83(5):609-18. Christgau M, Hiller KA, Schmalz G, Kolbeck C, Wenzel A. Accuracy of quantitative digital subtraction radiography for determining changes in calcium mass in mandibular bone: an in vitro study. Journal of Periodontology Research. 1998;33(3):138-49. Bohay RN, Stephens RG, Kogan SL. A study of the impact of screening or selective radiography in the treatment and postdelivery outcome in edentulous patients. OOOOE 1998;86(3):353-9. White SC, Pullinger AG. Impact of TMJ radiographs on clinician decision making. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:375-81. Liang H, Tyndall DA, Ludlow JB, Liang LA, Nunn NE. Accuracy of mandibular cross-sectional imaging with tuned-aperture computed tomography (TACT), iteratively reconstructed TACT, and multidirectional, linear, and transverse panoramic radiography. OOOOE 2001;91(5):594-602. Rushton VE, Lorner K, Worthington HU. Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria. OOOOE 2002;93(4):488-95. The Wuehrmann Prize is given to a paper published in OOOOE between July of the previous year and June of the year the prize is to be given. Papers eligible for the prize are those that present basic/clinical/epidemiological/survey research of relevance to OMFR that adheres to the principles of the scientific method. Position papers, case reports, and review articles are not considered for the Prize. Papers are judged based upon: (a) relevance to OMFR, (b) originality of research objectives and/or ideas presented, (c) innovativeness of study design (novelness of approaches/concepts), (d) appropriateness of epidemiological/statistical methods, and (e) clearness of presentation. The Awards Committee selects a Wuehrmann Prize Subcommittee, consisting of the Journal Section Editor as chair and 4 members of the Editorial Board, with a rotating membership. The Editor identifies approximately 7-10 notable articles meeting the criteria and provides the subcommittee with a list of these candidates within 2 weeks after publication of the June issue of OOOOE. Prior to this, subcommittee members may submit to the Editor titles of papers for consideration. The number of articles selected by the Editor for submission to the subcommittee is up to the discretion of the Editor. Each subcommittee member reads the candidate papers and ranks the top 5, sending the results to the Editor within one month. The Editor tallies the votes and notifies the Executive Secretary so the appropriate plaque can be made in time for the annual meeting. If there is not a clear winner after the first ballot, the subcommittee reaches consensus via e-mail and/or telephone discussion. Scanning the titles of the Prize winners reveals an interesting diversity of topics. New applications of technology, radiographic selection criteria, dental and jaw pathology, and an AAOMR position paper are included. Recognition of excellence in publishing should be a stimulating factor in the continuous improvement of the quality of articles in the Journal, and it is hoped that this Prize will result in that goal.

Effects of mandibular setback on the temporomandibular joint: A comparison of oblique and sagittal split ramus osteotomy

Purpose: This investigation studied the changes in temporomandibular joint function and condylar position after mandibular setback using different ramus osteotomies. Patients and methods: The sample consisted of 50 Chinese adults with mandibular prognathism. Twenty-eight of the patients underwent intraoral oblique ramus osteotomy (TORO), and 22 received sagittal split ramus osteotomy (SSRO) with rigid internal fixation (RIF). TMJ symptoms and radiographic findings were evaluated preoperatively and postoperatively. Results:After surgery in the TORO group, the TMJ radiographs showed a significant anterior-inferior displacement of the condyle. Seventy-five percent of the preoperatively symptomatic patients reported fewer or no TMJ symptoms and no preoperatively asymptomatic patients developed new TMJ symptoms. In the SSRO group, the TMJ radiographs showed a posterior displacement of the condyle. Sixty percent of the preoperatively symptomatic patients had no improved TMJ function and 8% of asymptomatic patients developed TMJ symptoms afer surgery. Conclusion: The results of this study show that TORO with MMF appears to be more favorable to the TMJ than the SSRO with RIF; TORO is particularly good in orthognathic surgery patients with preoperative TMJ symptoms.

総義歯治療により下顎頭のリモデリングを認めた症例

In a longitudinal observation case, it was found that morphological changes of the condylar head can be achieved by complete denture treatment.A 60-year-old edentulous female visited our clinic with complaints of spontaneous pain around the left TMJ and limitation of mouth opening (18 mm). MRI and TMJ radiograph showed osteophyte at the left condylar head, and internal derangement with anterior displacement without reduction of the left meniscus were observed.Through subsequent mandibular repositioning treatment of the patient, with the complete dentures applying centric relation as a treatment position, the condylar head shape and osteophyte were restored within 15 months. Clinical findings such as pain and mandibular disturbance disappeared after the initial three months following treatment, and kinesiologically, mandibular movement during open-close and chewing were improved.Therefore, it is suggested that abnormal changes of the condylar head are closely related to occlusion. Furthermore, it can be suggested that effective mandibular repositioning can be achieved by applying complete dentures as centric relation during treatment.

Implementation of an oral and maxillofacial radiology image management and communication system.

To implement an oral and maxillofacial radiology image management and communication system (OMFR IMACS) in the School of Dentistry, National Taiwan University. An OMFR IMACS has been implemented over 3 years in three phases: (1) Establishment of an OMFR image processing laboratory for research and graduate student training; (2) Installation of network infrastructure and (3) Total system integration. Intraoral, panoramic, cephalometric, and TMJ radiographs are directly processed with digital image acquisition devices or are converted into a digital format for viewing via UTP cable through FastEthernet in the eleven different divisions of the school. The system archives about 400 Mb of imaging data daily, representing 80% of the workload of the OMFR Division. The system is now used parallel to the conventional film-library system and has been integrated as part of the oral health service.

THE IMPORTANCE OF DETERMINATION OF JAW POSITION IN ORTHODONTIC DIAGNOSIS AND TREATMENT PLANNING FOR ADULT PATIENTS

The basic data needed for orthodontic diagnosis and treatment planning include color prints of soft tissue facial profile, intraoral dental arches, and occlusion; cephalometric and panoramic radiographs; and dental casts. Hand-wrist and TMJ radiographs are also necessary in some circumstances. If orthodontic diagnosis and treatment plans are made only from the dental alignments and occlusion from the static or hand-assembled dental casts, the diagnosis and treatment planning made may be wrong in some cases. Clinically, it is necessary to find the centric relation of the lower jaw and to transfer the jaw relationship to the articulator. Correct diagnosis and orthodontic treatment planning may then be made from the findings of the occlusal relationship from the articulator accompanied with the information on skeletal age and craniofacial characteristics from the hand-wrist and cephalometric radiographs. Four clinical cases have been presented to demonstrate the importance of determination of jaw position in orthodontic diagnosis and treatment planning in adult patients.

総義歯患者の術前後における顎顔面形態の変化とそしゃく筋活動パターン

It has been said that long-term denture wearers often undergo facial changes as a result of not only occlusal wear of the dentures and residual ridge resorption but also masticatory dysfunction. However, there are no references regarding analysis of morphological change in relation to the functional masticatory muscle activity which is fundamental to an understanding of maxillomandibular relation.The purpose of this study was to investigate whether or not a method of mandibular repositioning that changes the facial skeletal structure can correct mandibular dysfunction. Sixty patients were examined who required denture renewal. Diagnosis of these patients was made, and a clinical method, following standardized treatment, was determined for obtaining correct mandibular position. Patients were evaluated before and after treatment using lateral and P-A cephalogram, transcranial TMJ radiograph, and EMG for bilateral coordination patterns of masticatory muscles.The results were as follows:1. In long-term use of complete dentures, there was a loss of occlusal vertical dimension and the mandible rotated counterclockwisely resulting in an increase in relative prognathism.2. Loss of occlusal vertical dimension coupled with a habitually protruded mandible was corrected by sufficient clinical procedure to correct jaw relation.3. Mandibular function could not be achieved without correction of the facial skeletal structure.

Impact of TMJ radiographs on clinician decision making

Objectives This study examined the influence of lateral and frontal temporomandibular joint tomograms on the initial diagnosis and treatment plan of patients having facial or preauricular pain or temporomandibular joint disorders. Study design Five or six general dentists, all with experience in treating patients with disorders of the temporOmandibular joint, examined records of 105 patients from a university-based orofacial pain clinic. The examiners proposed a diagnosis and treatment plan for each patient without the benefit of tomograms. They then repeated this procedure after study of the radiographs. The impact of the radiographs was measured as the change in pre- versus postradiographic diagnosis and treatment plan. Results The availability of temporomandibular joint tomograms changed or modified diagnosis in 65% of the judgments and influenced treatment recommendations in 40%. These changes were substantive for 21% of the diagnoses and 22% of the treatment plans. The strongest correlation to changes in both diagnosis and treatment plan was with radiographic detection of osseous changes. New information about condyle position had less effect on clinical decisions. Conclusions These findings indicate that temporomandibular joint tomograms play a valuable role in influencing clinician's diagnosis and treatment plan of patients with disorders of the temporomandibular joint.

Efficacy of TMJ radiographs in terms of expected versus actual findings

Objectives The purpose of this study was to measure the amount of new information contributed by temporomandibular joint tomograms beyond that anticipated by the patient's clinical presentation. Study design The results of a clinical examination and history, including a video of patient interview, and dental casts of 105 patients with a temporomandibular disorder were presented to a panel of general dentist evaluators with some experience in temporomandibular disorders. These evaluators then described the radiographic findings they anticipated. Lastly they examined temporomandibular joint tomograms for each of the study patients and scored their findings. Results The temporomandibular joint tomograms revealed unanticipated osseous changes in 61% of case judgments of condyles and 47% for the temporal bone or 34% and 22%, respectively, when subtle changes were excluded. Unexpected condyle positional findings were revealed in 31% of the patients. When stratified by clinical class, osteoarthritis and internal derangement, false-positive and false-negative interpretations were 12.1% and 25.5%, respectively, for osteoarthritis, and 12.2% and 17.3% for derangement. Conclusions The fairly high rate of unexpected new osseous and positional findings supports the need for tomograms in patients with a clinical diagnosis of derangement or osteoarthritis.

Unexpected TMJ responses to functional jaw orthopedic therapy

The activator, the Bionator, the Fränkel, and, more recently, the Herbst appliances have enjoyed increasing popularity. Although an increase in mandibular growth has not been shown to be clinically consistent or always significant, the popularity of these appliances continues. Another clinical goal of these functional jaw orthopedic (FJO) appliances is to correct, maintain, or protect the integrity of the TMJ—specifically, to prevent posterior condylar displacement and/or anterior disk displacement. Because all FJO appliances anteriorly reposition the condyle during treatment, it is hoped that internal derangement problems may be resolved during treatment. Even though a single TMJ radiograph is not diagnostic in itself, multiple radiographs are helpful in monitoring the net changes in the condylar position during treatment. The relative (or net) change in the condylar position may provide clues to what occurred during treatment. However, TMJ responses are not always predictable during FJO treatment. Three case histories are presented that illustrate unexpected TMJ responses in which the condyles were still posteriorly displaced in spite of FJO treatment. Only 2% to 3% of the author's practice responds in this manner and no physiologic mechanism is suggested. These findings point out the complexity of the TMJ and its treatment, regardless of the appliance, and emphasize that no one approach to TMJ treatment will always be efficacious.

Design, evaluation, and use of a temporomandibular arthrometric cephalostat, the Porta-Stat (an X-ray subsystem). Part II. Use.

AbstractThis article documents the clinical use of a new device (Porta-Stat TMJ)designed to make clear and reproducible lateral transcranial TMJ radiographs. Anecdotal cases presented demonstrate the clinical usefulness of individually standardized TMJ radiographs. The device has proven useful in the management of cases needing reliable documentation of change in condylar position, as in mandibular fracture, orthognathic surgery, and TMJ diagnosis, treatment, and pathology.

Temporomandibular joint dysfunction: Report of a case

Occlusal bite splint therapy and the application of sound principles of functional occlusion resulted in a definitive diagnosis and successful orthodontic re-treatment of a patient with chronic disorder of the left temporomandibular joint. This case report demonstrates that latent mandibular growth and orthodontic retention can produce anterior premature centric contacts. The anterior prematurities prevented the posterior teeth from occluding without the left condyle first dislocating from the glenoid fossa. Occlusal bite splint therapy allowed the mandible to move to a position of greater maxillomandibular stability, illustrating the need for anterior freedom for the mandible. The patient became asymptomatic 1 month after slight intrusion and changing of the axial inclination of the maxillary incisors, which provided a freedom of centric occlusion and allowed the condyle to seat in the fossa. TMJ radiographs supported the clinical findings.

Evaluation of condylar position from temporomandibular joint radiographs

This investigation evaluated the accuracy of three different transcranial TMJ radiographic records of condylar position and joint space dimension. In addition, the study evaluated how reliably observers determined condylar position and joint space dimensions from the radiographs. The results of this investigation support the following conclusions. The classification of condylar position is not the same at different sagittal locations within a TMJ. Skull position and radiographic projection must be identical if joint space measurements from serial radiographs are to be compared. The actual joint space dimensions and the anatomic anterior/posterior position of the condyles in the glenoid fossae cannot be accurately recorded by the radiographic techniques used in this investigation. Condyle/fossa relationships cannot be classified reliably by subjective evaluation of TMJ radiographs.

Head position for transcranial temporomandibular joint radiographs

Proper angulation is important for clear transcranial TMJ radiographs. Because of individual anatomic variations, it is essential that a variable head positioner device be used. Variations in the vertical and horizontal angulation of the x-ray beam will affect the relative position of the TMJ, the petrous line, and the posterior clinoid process (Fig. 11). If other anatomic structures are superimposed on the condyle and fossa, interpretation of normal or pathologic anatomy may not be possible.

Practical evaluation of the lateral temporomandibular joint radiograph

The reevaluation of the lateral transcranial radiograph is needed because of the confusion that surrounds the diagnosis and treatment of TMJ dysfunction-pain. The lack of universal acceptance of the validity of the lateral TMJ radiograph contributes to the lack of progress of TMJ dysfunction-pain treatment and improved methods for the treatment of prosthodontic patients. The lateral transcranial TMJ radiograph was reevaluated for its duplicability (+/- 0.2 mm). The image was found to be a cross section of the lateral third of the condyle rather than a composite view of the condyle made at an angle. The condylar position in the fossa can be correctly evaluated in transcranial radiographs, because the relative condylar position in the fossa is similar in all sagittal views and the image is always of the same sagittal plane (lateral third). Soft tissue within or lining the fossa does not affect the evaluation of condylar position. Chronic osteoarthritic TMJ pathology can exist without subjective pain; therefore, routine use of initial TMJ radiographs with subsequent radiographs at 5-year intervals is suggested for all patients. Because condylar repositioning may be indicated before subjective pain symptoms appear, condylar repositioning should be contemplated whenever extensive prosthodontic treatment is needed. In addition, if chronic osteoarthritic lesions are observed initially, radiographs are indicated at more frequent intervals and anti-inflammatory agents should be considered for routine use depending on the rate and extent of the pathologic development. The existence of osteoarthritic lesions was confirmed by serial radiographs over 5 to 10 years. If an osteoarthritis is present, condylar repositioning (when condylar displacement is present) or changes in occlusion should be considered. There is some clinical evidence that condylar displacement is associated with pathologic remodeling and/or osteoarthritic lesions of the condyle and that condyle repositioning arrests the pathologic process. The principle of condylar concentricity , previously established for the treatment of TMJ dysfunction-pain syndrome and for functional centric relation in prosthodontics, was formulated by associating condylar position in the fossa with TMJ dysfunction-pain in many patients. This article suggests the value of the lateral TMJ radiograph as an important practical aid in the diagnosis and treatment of TMJ dysfunction pain and in the establishment of functional centric relation in prosthodontics.

Definitive prosthodontic therapy for TMJ patients. Part II: Posterior and superior condylar displacement

Examples of anterior condylar repositioning were given for fixed and removable partial denture prostheses without changes in the vertical dimension of occlusion. A superior condylar displacement was treated with a temporary acrylic resin inferior repositioning prosthesis, followed by a gold onlay for over a year. Subsequent final porcelain-fused-to-gold restorations preserved the therapeutic inferior condylar repositioning. The treatment procedures are the same in principle for all patients, that is, the diagnosis and the fabrication of the provisional treatment prosthesis and the final prosthesis are carried out with the specific guidance of lateral transcranial TMJ radiographs. The patient must be comfortable in the planned treatment position for at least 3 months before final restorative procedures are initiated. The repositioned condyles in the fossae are reproduced in the final prosthesis and documented at each step of the procedure radiographically. The TMJ lateral transcranial radiograph, then, is a direct guide to the diagnosis, treatment prosthesis, and final prosthodontic restoration.

The role of stress, occlusion, and condyle position in TMJ dysfunction-pain

Lateral transcranial TMJ radiographs are duplicable within ±0.2 mm and are cross-sectional views of the lateral third of the condyle and fossa. The innate asymmetry of humans, when the right and left sides of the fossa and condyle are compared, was clinically insignificant. Tomograms are not indicated because they lack appropriate resolution and detail to evaluate qualitative bone changes; and because they are not an in-office procedure, the condylar position in the fossa is completely unreliable. A correlation was reported between condylar position in the fossa and TMJ dysfunction in over 320 patients. This observation suggests that a new definition of centric relation is indicated, a definition that differentiates whether it is functional or dysfunctional. The criterion is the correlation between the occlusal findings and the condylar position in the fossa as recorded by the lateral TMJ radiographs (when the teeth are in maximum occlusion). Stress response was found to be greater in males than in females (in all vertebrates, including humans); therefore stress cannot be a direct cause of craniomandibular pain since more women have the disorder. It was concluded that stress is an indirect contributing factor that usually works through the medium of clenching. The role of the neuromuscular mechanism in craniomandibular pain was discussed. Proprioception reflex activity forms the basis for muscle length, mandibular positional sense, as well as masticatory function. Occlusal disharmonies increase noxious input to the neuromuscular system, as well as stress-induced clenching, causing increased muscle activity and spasm-pain. Condylar displacement also contributes to TMJ dysfunction-pain, depending on its direction. Anterior condylar displacement can initially affect the muscles by inducing overfunctional response in the proprioceptive system. Posterior condylar displacement usually results in an intrajoint response consisting of a disk derangement, reciprocal clicking, possible anterior disk dislocation, possible pathologic swallowing pattern, and noxious stimulation to the proprioceptive system. These factors contribute to subsequent trismus, muscle spasm and pain, and long-term pathologic remodeling of the joint. A detailed history is necessary to evaluate the role of stress. The physical occlusal findings are correlated with the condylar displacement observed in the TMJ radiographs to diagnose and plan corrective treatment.

TMJ radiograph of subjects with/without dysfunction in Mexican population

TMJ radiograph of subjects with/without dysfunction in Mexican population

各種の咬合検査法を用いたオーラル・リハビリテーションについて

Methods of occlusal diagnosis for oral rehabilitation were discussed. Among the methods, one employing articulator has been popular for a long time. Krough-Poulsen's palpation became popular rather recently. And now, functional occlusal diagnosis employing Dental Electronic apparatus including dental sound checker and Mandibular kinesiograph are available.Further, standardization of TMJ radiographs provides access for using them in occlusal diagnosis. These old and new methos are not effective by itself, but helpful for occlusal diagnosis when the result of each method were comprehended and combined thoroughly.This report dealt with the knowledges and techniges being necessary to operate those methods so that the dentists can use those as proper diagnostic means for determining occlusion.