Transcranial Radiographs Research Articles

Concordance among three diagnostic methods for determining the position of the mandibular condyle

The position of the condyle can be determined using different diagnostic tools, among which are transcranial X-rays (RT), Cone Beam Computed Tomography (CBCT), and the Condylar Position Indicator (CPI). This study aimed to determine the concordance among the CPI, the CBCT, and the RT as diagnostic methods for determining the condyle position. Materials and method: 32 valid cases, each of which had an RT, a CBCT, and a CPI, were analyzed by three observers. SPSS V. 26.0 program was used to calculate the Kappa trust interval, using the jackknife technique which allows to estimate of the standard error between observers. To evaluate the condylar position using CPI, an AD2 articulator was employed. A Pullinger and Hollender layout was used in the tomographic and transcranial images. Results: The concordance among the three observers for each method resulted in a value of Kappa higher than 0.879. The concordance between CBCT and RT was 0.0627, between CPI and RT it was 0.247, and between CBCT and CPI it was .188. Conclusion: The level of concordance obtained between the three observers with any given diagnostic method was very good, which indicates that the concordance that each observer obtained regarding each diagnostic method is trustworthy. In this study, it is concluded that there is a concordance in the diagnosis regarding the position of the condyle of the tomography with the transcranial radiography. There is no concordance between tomography and CPI. There was also no concordance between the CPI and the transcranial radiography.

Evaluation of temporomandibular joint disorders using cone beam computed tomography

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The aim of this study was to evaluate efficacy of segmental cone beam computed tomography (CBCT) in detecting bony changes in condyle and thickness of roof of glenoid fossa in temporomandibular joint (TMJ) disorders.</span></p><p class="abstract"><strong>Methods:</strong> The study group comprised of 10 temporomandibular disorders (TMD) patients of either sex between the age group of 20-60 years diagnosed as TMDs by clinical evaluation using the research diagnostic criteria was considered. After the clinical examination, radiographic investigations were carried out which included digital OPG, transcranial radiograph and CBCT scan. TMJ Evaluation included: (a) bony changes of the condyle (flattening, erosion, sclerosis, osteophytes, resorption); (b) joint space (normal, increased, reduced, bony contact between the condyle and the mandibular fossa); and (c) bony changes of mandibular fossa (normal, sclerosis, erosion, resorption). The radiographic findings were statistically analysed.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Significant difference between OPG, transcranial and CBCT were found for the presence of erosion (P =0.000), thickness of roof of glenoid fossa (P =0.000), deformed contour (P =0.001), joint space (P =0.011), subchondral sclerosis (P =0.011), irregularity of articular surface and eminence (P =0.000), flattening (P =0.050). </span></p><p class="abstract"><strong>Conclusions:</strong> Using CBCT as imaging technique in our study to detect osseous changes in the TMJ was proved to be effective as compared to the conventional radiographic techniques, the results achieved with CBCT was 100%.The results obtained in our study prove to be a full proof one and it seems to promise to go one step closer to detect progression and severity of the osseous changes in the condylar head and mandibular fossa in patients with TMDs<span lang="EN-IN">.</span></p>

Uso da radiografia transcraniana para detectar alterações morfológicas no côndilo mandibular

RESUMO Objetivo: o objetivo deste estudo foi avaliar a acurácia das radiografias transcranianas (TRANS) convencionais na identificação das alterações morfológicas nos côndilos mandibulares. Métodos: a amostra consistiu em 36 côndilos mandibulares, obtidos a partir de 18 crânios secos humanos, aleatoriamente selecionados, sem identificação de idade, gênero ou etnia. Três especialistas em radiologia oral examinaram as TRANS para identificar possíveis alterações nos côndilos. Um quarto examinador realizou o exame macroscópico, que foi considerado o padrão ouro do estudo. As imagens das TRANS e os exames macroscópico foram classificados como (1) côndilos com alteração ou (0) côndilos sem alteração. A análise estatística foi realizada através do teste X 2 e da curva ROC (receiver operator characteristic). O teste Kappa intra e interexaminadores foi realizado para os examinadores 1 a 3. Resultados: o teste X2 mostrou uma associação estatisticamente significativa entre as alterações no côndilo vistas nas imagens TRANS e a presença de alterações macroscópicas (p ( 0,05). A área sob a curva ROC foi de 0,83, com 96% de sensibilidade e 70% de especificidade. O valor Kappa para a concordância intraobservador foi de 0,78, enquanto que a concordância interexaminador foi de 0,71. Conclusão: o uso de radiografias transcranianas apresentou-se como método eficaz para a detecção de alterações morfológicas no côndilo mandibular.

Prosthetic rehabilitation for a patient with CO-MI discrepancy

Centric occlusion-maximum intercuspation (CO-MI) discrepancy is one of main causes of evoking premature contact and resultant mandibular shift. These non-physiological conditions can induce temporomandibular disease, periodontitis, and non-carious cervical lesion. Therefore, if CO-MI discrepancy exists in patients who need extensive prosthetic rehabilitation, it must be corrected and then physiological occlusion must be restored. This report describes the treatment procedure of removing CO-MI discrepancy and prosthetic rehabilitation in a patient with 3.5 mm discrepancy, multiple caries and periodontitis. Proper mandibular position and modified opening & closing movement were confirmed by ARCUSdigma II and transcranial radiograph.

측두하악관절의 개구성 과두걸림 환자의 골격적 특성에 관한 연구

본 연구는 측두하악관절의 개구성 과두걸림과 골격적 특성 사이의 연관성을 분석하고자 개구성 과두걸림 환자를 대상으로 측두두부방사선 사진과 횡두개촬영 방사선 사진을 이용하여 두개골의 골격적 특성 및 관절 융기의 기울기를 비교 분석하였다. 개구성 과두걸림 환자를 환자군으로 하고 개구성 과두걸림은 없지만 측두하악장애 연구진단 기준(Research Diagnostic Criteria for Temporomandibular Disorder; RDC/TMD) Axis I에 따라 측두하악장애으로 진단된 환자를 측두하악장애 환자군, 개구성 과두걸림과 측두하악장애가 모두 없는 정상 환자를 정상군으로 설정하고 순차적으로 수집된 환자군 50명과 성별 및 연령이 일치하도록 무작위로 측두하악장애 환자군과 정상군, 각각 50명의 임상기록을 선별하였다. 측두하악장애에 영향을 줄 수 있는 관절염이나 외상의 병력, 악안면 기형, 악안면 수술 병력이 있는 환자는 모두 제외하였다. 세 군의 측두두부규격방사선 사진과 횡두개촬영 방사선 사진을 분석하여 골격적 특성과 관절 융기의 기울기를 측정하였다. 두개골과 하악과의 골격적 특성을 나타내는 측두두부방사선 사진을 분석한 결과 개구성 과두걸림이 있는 환자군에서 하악의 전후방적 위치를 나타내어주는 saddle angle이 더 작은 것으로 나타났으며 이는 두개골에 대해 하악이 더 전방으로 위치하고 있음을 나타낸다. 또한 횡두개촬영 방사선 사진상에서는 개구성 과두걸림 환자군이 측두하악장애 환자군과 정상군보다 관절융기의 기울기가 더 크게 관찰되었다. 이러한 결과는 두개골에 대해 측두하악관절이 더 전방으로 위치하고 관절 융기가 더 급한 경사를 가질 경우 개구성 과두걸림이 발생할 가능성이 더 크다는 것을 의미한다. This study was performed to investigate the skeletal factors related to open lock of the temporomandibular joint(TMJ). We compared the skeletal measurements on the cephalogram and transcranial radiograph among 3 groups, open lock group consisting of consecutively filed 50 patients with at least one open lock episode within recent 1 year, temporomandibular disorder(TMD) group of 50 TMD patients without open lock diagnosed by Research Diagnostic Criteria for TMD (RDC/TMD) Axis I, and normal group of 50 patients without TMD or open lock. The patients of TMD and normal group were randomly selected in an age-and-gender-matched way with ones of open lock group. Open lock group showed smaller saddle angle than normal group on cephalograms and steeper inclination of the articular eminence than TMD and normal groups on transcranial radiographs. These results imply that the patients with the joint located more anterior and the articular eminence with steeper inclination might be riskier to TMJ open lock.

Reduced joint distance during TMJ movement in the posterior condylar position

Biomechanical loading reduces joint distance and has a causative relationship with disc displacement in temporomandibular joint and/or osteoarthritis. Condylar movement and pathways during mouth opening and closing are different depending on the condylar position in the glenoid fossa. Therefore, physical loading on the articular disc or condylar head would also be different in different condylar positions. The aim of this study was to evaluate the 3-dimensional changes of joint distance in different anterior–posterior condylar positions. We divided 52 temporomandibular joints into anterior, concentric, and posterior condylar positions using transcranial radiographs. We traced the condylar movements by simulating mandibular movement with 3-dimensional computed tomography data and a position-tracking camera. The joint distance during temporomandibular joint movement was significantly narrower, and the length of condylar pathways with narrower joint distance was longer in the posterior condylar position than in the concentric (p < 0.05) or anterior condylar positions (p < 0.01). Our study suggests that the posterior condylar position experiences more physical loading than other positions. Therefore, the position may have an accelerating or worsening effect on biomechanical loading-related temporomandibular joint disorder in cases of harmful parafunctional activities such as excessive mouth opening, clenching, and bruxism.

측두하악관절 골관절염 환자의 진단에서 단층촬영과 골스캔 검사의 유용성에 대한 예비연구

측두하악관절 골관절염은 관절조직에 가해지는 과부하에 의해 관절면과 하부 골조직에서 일련의 퇴행성과정과 함께 관절부의 국소적 압통, 하악운동에 의한 관절의 염발음, 하악의 운동범위 제한, 심한 경우에는 과두지지가 없어져 구치부 과다접촉과 전치부 개교합이 나타날 수 있는 퇴행성질환이다. 일반적으로는 임상검사 후 파노라마방사선사진, 측두하악관절 파노라마, 경두개방사선사진을 촬영한 뒤 진단하게 되는데 이들 일반적인 방사선사진들은 질환 초기의 미세한 골변화를 평가하는데 제한적이다. 따라서 본 연구에서는 일반방사선학적 검사에서 골조직의 퇴행성변화가 의심되어 확진을 위해 단층촬영 및 골스캔 검사를 시행한 환자의 영상의학적 검사소견들 간의 일치도와 임상소견과의 관계를 평가하여 골관절염의 진단에서 이들 다양한 검사법들의 한계와 그 유용성을 평가하고 향후 추가연구를 위한 예비자료를 얻기위해 시행하였다. 골관절염의 진단에서 일반방사선사진과 단층촬영, 골스캔 검사의 결과 일치도가 비교적 높게 나타났지만 위음성 가능성이 존재하므로 임상검사소견에 따른 단계적인 영상의학적 검사 시행이 바람직할 것으로 사료된다. TMJ Osteoarthritis is a degenerative disease caused by overload on joint tissue, and often accompany with local tenderness on the joint, crepitus by mandibular movement, restriction of mandibular movement, and anterior openbite. In general, panoramic radiography, TMJ panoramic radiography, and transcranial radiography are conducted to diagnose osteoarthritis after clinical examination, however, these radiographic evaluations are limited in detecting minute bony changes of early pathologic lesion. The aim of this pilot study was to evaluate the limitation and usefulness of several TMJ imaging techniques, so we compare the findings from clinical examination, plain film radiographs, tomograph, and bone scan from 81 patients with temporomandibular joint disorder. The proportion of patients showing same findings in plain film radiographs, TMJ tomograph, and bone scan was high, however, it is desirable that clinician should conduct phased imaging examinations according to the clinical findings due to the possibilities of false negative findings in diagnosis of osteoarthritis.

Complete dentures with N&amp;#243;bilo’s sliding plates: A condylar position and electromyograph analysis

Objective: This study was performed with the purpose a report clinical cases involving condylar position and Nóbilo’s sliding plates. Background: Patients may present temporomandibular disorder (TMD), which is characterized by pain in masticatory muscles, temporomandibular joints and limited mandible movements. Treatment involving oral rehabilitation with the use of complete dentures with Nóbilo’s sliding plates has been an alternative for the treatment of TMD. Materials and Methods: Nine patients with a history of TMD signs and symptoms (RDC/TMD)—in particular, muscular and articular pain—received pain evaluations, mandibular movement analysis, transcranial radiography and an electromyographic analysis of the masseter and temporalis muscles before and after the use of complete dentures with Nóbilo’s sliding plates. Results: After treatment, the patients had reduced painful symptoms, an increase in mandibular movement and adequate electromyographic activity. The normalized EMG data were ta-bulated and analyzed statistically using SPSS version 17.0 for Windows (SPSS Inc., Chicago, IL, USA), and the values were compared by umpaired independent Student’s t-test. Conclusion: The use of Nóbilo’s sliding plates promoted improvements in electromyographic activity, muscular pain and man-dibular movement.

The Occurrence of Degenerative Change in the Mandibular Condyles of Korean Patients with Temporomandibular Disorders

Osteoarthritis (OA), the most common form of arthritis, is a result of both mechanical and biological events that destabilize the normal coupling of degradation and synthesis of articular cartilage chondrocytes and extracelluar matrix, and subchondral bone. Although it is likely that the molecular basis of pathogenesis is similar to that of other joints, additional study of the temporomandibular joint (TMJ) is required due to its unique structure and function. This study was carried out to evaluate the epidemiologic characteristics of TMJ osteoarthritis. The purpose of this study was to investigate the prevalence of TMJ OA in Patients with temporomandibular disorders (1405 men and 2922 women whose mean age was 30.2 ± 15.4 and 33.1 ± 15.2 years, respectively) who had visited the TMJ and Orofacial Pain Clinic of Seoul National University Dental Hospital in 2007. Orthopantomograms, TMJ tomograms and transcranial radiographs were used to evaluate degenerative change of the mandibular condyle. The obtained results were as follows: 1. Degenerative change of the mandibular condyle was observed in 883 (20.4%) of 4327 subjects. The prevalence was significantly higher in women (706 patients, 24.1%) than in men (177 patients, 12.6%), and this significant difference between genders was observed in all age groups. 2. The prevalence of degenerative change of the mandibular condyle in TMD patients showed a gentle increase along with age. Such increase was statistically significant in women (P＜0.001), but not in men. 3. Sclerosis was observed the most frequently in all age groups and the mean age of the patients with osteophyte was the highest among four types of degenerative change. 4. Although men showed degenerative change in the left side more often and women showed degenerative change more frequently in both sides, the difference of distribution in sides between genders was not significant. In conclusion, the prevalence of degenerative change of the mandibular condyle in TMD patients is higher in women than in men, and increases steadily with aging, but not as dramatically as in other joints that show a steep increase in prevalence around the age of 45 years. It can be suggested that the epidemiologic characteristic of OA of the TMJ differs from those of other joints, and that a more extensive study based on the general population is necessary.

Cephalometric Characteristics of TMD Patients based on RDC/TMD Axis I Diagnosis

The aims of this study were to investigate whether the facial skeletal patterns previously reported to be related to temporomandibular disorder (TMD) in other studies could be consistently observed in the TMD patients diagnosed according to Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) Axis Ⅰ and evaluate its usability in the orthodontic clinics to examine the patients with TMD related symptoms. The clinical records and radiographs of female patients who visited the TMD and Orofacial Pain Clinic of Seoul National University Dental Hospital and were diagnosed as TMD were consecutively filed for this study. Patients were clinically examined and diagnosed according to the revised diagnostic algorithms of RDC/TMD Axis Ⅰ and the lateral cephalogram, panoramic orthopantomogram, temporomandibular joint (TMJ) orthopantomogram, and transcranial radiograph of each patient were taken and digitalized. The data of patients who were under 18 years of age or had any systemic disease, trauma history involving the TMJ, or skeletal deformity at the time of the first examination were excluded. The remaining data of 96 female patients were finally analyzed. The obtained results were as follows: 1. There are no significant differences of cephalometric measurements between RDC Ⅰ (muscle disorders) diagnostic groups. 2. Only the articular angle of the RDC group Ⅱc (disk displacement without reduction without limited opening) patients was larger than patients of the no diagnosis of RDC Ⅱ group (disk displacement). 3. Larger articular angle and smaller facial height ratio were observed in RDC Ⅲc group (osteoarthrosis) compared to Ⅲa group (arthralgia). Larger articular angle, larger Bjork sum, smaller posterior facial height, and smaller facial height ratio were observed in RDC group Ⅲc compared to no diagnosis of RDC Ⅲ group (arthralgia, arthritis, and arthrosis). 4. According to the results of cephalometric analysis in simplified RDC groups, smaller overjet was observed in muscle disorders (MD) group. Facial height ratio and IMPA were smaller and articular angle was larger in disk displacements (DD) group than in no diagnosis of DD group. In arthrosis (AR) group, posterior facial height, and facial height ratio were smaller, and articular angle, gonial angle, facial convexity, FMA, Bjork sum, and ANB were larger than in no diagnosis of AR group. In joint pain (JP) group, only posterior facial height was smaller than no diagnosis of JP group. In conclusion, Facial morphologic patterns showing posterior-rotated mandible and lower posterior facial height is related to RDC group Ⅱ and Ⅲ diagnosis of the TMJ in female TMD patients. RDC/TMD Axis Ⅰ diagnosis can provide a good clinical diagnostic tool for the standardized examination of the TMJ in orthodontic clinics.

Comparison of transcranial radiograph and magnetic resonance imaging in the evaluation of mandibular condyle position

Several image modalities have been used to assess the condylar position in the glenoid fossa. However, despite the development of more advanced techniques for imaging the temporomandibular joint (TMJ), the transcranial projection remains widely used in dentistry. The purpose of this study was to compare the condylar position in transcranial radiography (TRANS) with MRI. 70 matched pairs of TMJs (35 patients) who had undergone TRANS and MRI were evaluated. The TRANS scans were compared with the lateral, central and medial MRI scans, and the condylar position was assessed in the closed and open mouth position according to subjective and objective methods. The sensitivity, specificity and accuracy values were calculated for each group and Bowker's test was used to analyse the data. There was no statistical significance between TRANS and MRI (P > 0.05). However, even though there were similar mean values between them, the comparison with the lateral image showed higher values, which might be due to TRANS representing the lateral one-third of the condyle. It can be concluded that TRANS seems to be an acceptable method and its applicability as an adjunctive method in the condylar position should not be rejected.

Hypertrophy of the mandibular coronoid process and structural alterations of the condyles associated with limited buccal opening: case report

This paper reports the case of a patient who presented limited buccal opening, though, without apparent symptomatology. The patient was partially toothless and exodontia of the remaining teeth was indicated. Clinical examination and clinical interview were performed as well as panoramic radiograph, transcranial radiograph of the temporomandibular joints (TMJ) and, later, computed tomography (CT), emphasizing the importance of complementary exams in the diagnostic phase. Analysis of the CT scan confirmed the structural alteration in the condylar and coronoid processes of the jaw, explaining the limited buccal opening. The remaining teeth were extracted and complete upper and lower dentures were fabricated, reestablishing the occlusal relationship and the patient's stomatognathic functions. Surgical treatment of the coronoid process was discarded.

Changes in condylar mobility and radiographic alterations after treatment in patients with non-reducing disc displacementof the temporomandibular joint

The purpose of this study was to examine changes in condylar mobility and morphological changes in the affected condyles after treatment in patients with non-reducing disc displacement of the temporomandibular joint (TMJ). Changes in condylar mobility and morphological changes of the condyle were examined radiographically in 55 patients who were diagnosed as having non-reducing disc displacement of the unilateral TMJ and had received pumping with injection of sodium hyaluronate. In all patients, standardized lateral oblique transcranial radiographs and panoramic jaw tomograms were taken both at initial visit and at 12 months or more follow-up (mean 28.1 months after treatment; range 12-104 months). 42 joints in 21 persons with no current or previous TMJ symptoms served as a control. Clinical signs and symptoms improved after treatment in the patients. Condylar mobility significantly increased after treatment in patients (P<0.001), although it did not reach levels of the control group. Frequency of radiographic changes of the condyle significantly increased after treatment (P<0.005). In most of the patients, no or only mild changes were observed. Frequency of changes of the condyle in patients at follow-up was significantly greater than that in controls (P<0.001). In the patients, condylar mobility increased in the subsequent course after treatment. However, bony changes of the condyle appeared more frequently. Long term-follow-up after treatment on bony changes of the condyle seems to be necessary in patients with non-reducing disc displacement of the TMJ.

Estimativa da excursão condilar em pacientes com disfunção craniomandibular: um enfoque multidisciplinar

OBJETIVO: avaliar o padrão de excursão condilar em pacientes com disfunção craniomandibular. METODOLOGIA: a estimativa da excursão condilar da ATM foi estudada em 17 pacientes, 34 ATMs do Serviço de Cirurgia Bucomaxilofacial do Hospital Jaraguá-São Paulo/SP, todos com diagnóstico de disfunção craniomandibular. Foi utilizado o exame radiográfico do tipo transcraniano para verificar a estimativa da excursão condilar, bem como o índice de Helkimo, para classificar o grau de disfunção de cada paciente. As ATMs de cada paciente foram examinadas por três diferentes profissionais com auxílio do exame radiográfico. O exame clínico observou dados como raça, gênero, a queixa principal de cada paciente, presença de dor pré-auricular, dor muscular, estalo nas articulações e limitação da abertura da boca. RESULTADOS E CONCLUSÕES: a dor pré-auricular e os estalidos foram as principais queixas dos pacientes. A excursão condilar mais freqüente foi a normoexcursão, seguida da hiperexcursão, associada com o grau II de disfunção articular de Helkimo.

Evaluation of condylar position from transcranial projections in primary dentition

To evaluate the condylar position through transcranial radiographs in children between 3 years and 6 years old and to associate it with morphological characteristics of primary dentition. The extraoral transcranial radiographs were taken with plain films using the Accurad-200 head holder (Denar Company, Anaheim, CA), and then they were digitized using a Hewlett Packard 6390 Scanner. The condylar position was determined according to Gelb's template, in postural rest position (RP) and maximum intercuspal position (MI), and it was associated with the characteristics: normal occlusion (n=36), open bite with or without overjet greater than 3 mm (n=27), unilateral or bilateral posterior cross bite (n=14), overbite greater than 3 mm (n=15). The chi-square and the Fisher Exact Test were used to analyse the data. It was verified that when using Gelb's template, there was not a significant association between the occlusion type found and the position of the condyle in the glenoid fossa when considering the entire patient sample (P>0.05). There was a great variability in positions, and most of the children had asymmetric condyles (55.43% in MI and 51.09% in RP). Children with normal occlusion and malocclusion presented the same proportions of condylar position in both mandibular positions. In conclusion, the results of this study showed that the condylar position in small children with different morphological occlusions presented great variability.

Alterações degenerativas em pacientes com disfunção crâniomandibular

Os processos degenerativos da ATM foram estudados em 17 pacientes, 34 ATMs do Serviço de Cirurgia Bucomaxilofacial do Hospital Jaraguá-São Paulo/SP, todos com diagnóstico de disfunção crâniomandibular. Foi utilizado o exame radiográfico do tipo transcraniano para verificação das degenerações articulares. As ATMs de cada paciente foram examinadas por três diferentes profissionais com auxílio do exame radiográfico. O exame clínico procurou observar dados como raça, gênero, a queixa principal de cada paciente, presença de dor pré-auricular, dor muscular, estalo nas articulações, e limitação da abertura da boca. A dor pré-auricular, e os estalos foram as principais queixas dos pacientes. As alterações degenerativas ocorreram mais nas mulheres com faixa etária entre 20 a 29 anos. Ocorreram na seguinte ordem decrescente: facetamento, eburnação e osteófito. As alterações foram mais marcantes no côndilo do que na eminência articular, já os facetamentos estiveram relacionados com a queixa principal de dor pré-auricular. Foi observado estatisticamente uma correlação de 70% entre o facetamento e a ebunação.

Solid-state temporomandibular joint imaging: accuracy in detecting osseous changes of degenerative joint disease and determining condylar spatial relations

The purpose of this study was to evaluate the off-label use of an intraoral charge-coupled device (CCD) for extraoral transcranial radiography of the temporomandibular joint. Corrected linear tomograms and transcranial images made with conventional screen–film combinations and a CCD detector were compared with sectioned cadaver specimens. Radiation dosage, qualitative assessment of condylar degenerative features, and condylar position within the glenoid fossa of the 3 modalities were assessed and compared. The CCD method required special adjustments to achieve adequate quality, and it involved greater exposure than the other methods. This use of this intraoral system for extraoral imaging cannot now be recommended, but future refinements might make it more viable.

補綴処置により前歯部開こうの改善を認めた慢性関節リウマチの１症例

A prosthodontic treatment of a 39-year-old female who had severe anterior open bite with rheumatoid arthritis was reported. Rheumatoid arthritis had been diagnosed 5 years previously, and she had been hospitalized for infection of the spine, shoulder and knee joints. In her medical history, the patient stated that her mandible had continued to gradually retrude for the past 3 years, resulting in severe anterior open bite.Because of the progressive nature of rheumatoid arthritis, the decision was made to perform a reversible procedure to apply a prosthesis made of acrylic resin for stable occlusal contact with a posterior tooth. Afterthe eighth month, even distribution of posterior tooth contact was acquired with decreased vertical overbiteof 1 mm. After maxillary anterior prosthesis made of acrylic resin were provided with suitable verticaloverbite and anterior guidance, the metal prosthesis were provided at fourteen months after the first examination.In this report, it was suggested that occlusal management could improve anterior open bite caused byrheumatoid arthritis of TMJ, however, lateral transcranial radiography of TMJ findings still showed deformityand flattening of the condyle and the articular eminence of bilateral TMJ after treatment.

ACHADOS RADIOGRÁFICOS, SINAIS E SINTOMAS NAS DISFUNÇÕES DA ARTICULAÇÃO TEMPOROMANDIBULAR

Os achados radiográficos e os sinais e sintomas de pacientes com disfunções da articulação temporomandibular (ATM) foram estudados. Através da incidência transcranial para ATM, foram verificadas a presença de alterações degenerativas e a estimativa de excursão condilar. Pelo exame clínico, foram avaliados dados como queixa principal, padrão de ocorrência de dor, sinais de dor muscular e sinais articulares de disfunção. As alterações radiográficas mais freqüentes foram as degenerativas. As alterações degenerativas mais freqüentes foram, em ordem decrescente, facetamento, eburnação e osteofito. As alterações degenerativas foram mais freqüentes no côndilo do que na eminência articular. A estimativa de excursão condilar foi, em ordem decrescente, normo, hiper e hipoexcursão. Não foi observada relação entre achados radiográficos e sinais ou sintomas específicos

Modified condylotomy for chronic nonreducing disk dislocations

Objectives. To retrospectively evaluate the modified condylotomy procedure for patients with chronic nonreducing disk dislocations of the temporomandibular joint. Study designs. Sixty-three patients underwent 78 modified condylotomies on temporomandibular joints that had chronic nonreducing disk dislocations and that were previously treated unsuccessfully with nonsurgical modalities. Patients were asked to evaluate their pain, headaches, bite, and success rate postoperatively. Comparisons of patients' preoperative and postoperative maximum incisal opening were also made. Transpharyngeal and transcranial radiographs were compared to determine condylar changes. Results. Ninety-four percent felt that their pain was better, one patient (2%) said that his pain was the same, and two patients (4%) felt that their pain was worse. Eighty percent considered their headaches were better, and one patient (2%) considered them worse. Seventy-eight percent said that their bite was the same or better, and 22% said it was worse. Three patients underwent a second surgery. Progressive condylar remodeling occurred in 81%, and regressive condylar remodeling occurred in 6%. The maximum incisal opening change was overall a positive change; 35% had a significant positive change, and 10% had a significant negative change. Conclusion. This retrospective study shows that the modified condylotomy should be considered as a surgical alternative in treating patients with chronic nonreducing disk dislocations that have been unsuccessfully treated nonsurgically.