Diagnostic evaluation of the temporomandibular joint osteoarthritis using cone beam computed tomography compared with conventional radiographic technology

Department of Oral Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Beijing 100081, China.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 03/2007; 39(1):26-9.
Source: PubMed


Osteoarthritic lesions of Temporomandibular joint(TMJ) were assessed by dental cone beam computed tomography(CBCT), and compared with conventional radiographic technology.
The study was conducted retrospectively on 511 joints of 350 patients, who had undergone dental CBCT, panoramic radiography, transcranial projection and transpharygeal projection of TMJ. The results were compared and the accuracy with CBCT was assessed. The types of osseous condylar abnormalities were observed.
(1) The occurrence of osteoarthritis in male and female were 59.04% and 69.66%, respectively, with no significant difference. (2) Compared with CBCT, panoramic radiography, transpharygeal projection examination showed no significant difference, with the accuracy being 90.64% and 94.10%, respectively; However, transcranial projection indicated a significant difference in comparison with CBCT and the accuracy was 86.97%. (3) A higher occurrence of osteoarthritic lesions of the condyle was sclerosis (39.86%). Bony proliferation or osteophyte (28.18%) and ill-defined cortical bone (18.90%) were followed.
Cone beam CT, which reproduces multiple images including axial, coronal and sagittal planes of the joint, provides a complete radiographic investigation of the bony components of the TMJ. It is one of the best choices of imaging diagnosis of TMJ osteoarthritis. Panoramic radiography and transpharygeal projection examination are also good choices for showing osseous condylar abnormalities in the clinic, but transcranial projection examination is inferior.

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    • "Three-dimensional (3-D) Cone Beam Computed Tomography (CBCT) systems [1] produce images with high resolution (100-300 micron) and minimal distortion, that allows evaluating osteoarthrosis in the temporomandibular joint (TMJ). It also allows for correlating the diagnosis to the age of the patient, [2,3] individuation of remodeling areas, [4] erosions, osteophytes, lines of fracture, bone resorption, [1] condylar displacement after orthognatic surgery, [5] or particular clinical evidences, such as the trifid condyle [6]. "
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    ABSTRACT: There have been no quantitative standards for volumetric and surface measurements of the mandibular condyle in Caucasian population. However, the recently developed cone-beam computed tomography (CBCT) system allows measurement of these parameters with high accuracy. CBCT was used to measure the condylar volume, surface and the volume to surface ratio, called the Morphometric Index (MI), of 300 temporo-mandibular joints (TMJ) in 150 Caucasian young adult subjects, with varied malocclusions, without pain or dysfunction of TMJs. The condylar volume was 691.26 ± 54.52 mm3 in males and 669.65 ± 58.80 mm3 in, and was significantly higher (p< 0.001) in the males. The same was observed for the condylar surface, although without statistical significance (406.02 ± 55.22 mm2 in males and 394.77 ± 60.73 mm2 in females).Furthermore, the condylar volume (693.61 ± 62.82 mm3 ) in the right TMJ was significantly higher than in the left (666.99 ± 48.67 mm3, p < 0.001) as was the condylar surface (411.24 ± 57.99 mm2 in the right TMJ and 389.41 ± 56.63 mm2 in the left TMJ; t = 3.29; p < 0.01). The MI is 1.72 ± 0.17 for the whole sample, with no significant difference between males and females or the right and left sides. These data from temporomandibular joints of patients without pain or clinical dysfunction might serve as examples of normal TMJ's in the general population not seeking orthodontic care.
    BMC Medical Imaging 12/2010; 10(1):28. DOI:10.1186/1471-2342-10-28 · 1.31 Impact Factor
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    ABSTRACT: Because their etiologies and pathogenesis are poorly understood, temporomandibular joint (TMJ) diseases are difficult to diagnose and manage. All current approaches to treatments of TMJ diseases are largely palliative. Definitive and rational diagnoses or treatments can only be achieved through a comprehensive understanding of the etiologies, predisposing factors, and pathogenesis of TMJ diseases. While much work remains to be done in this field, novel findings in biomedicine and developments in imaging and computer technologies are beginning to provide us with a vision of future innovations in the diagnostics and therapeutics of TMJ disorders. These advances include the identification and use of local or systemic biomarkers to diagnose disease or monitor improvements in therapy; the use of imaging technologies for earlier and more sensitive diagnostics; and the use of biomedicine, biomimetics, and imaging to design and manufacture bioengineered joints. Such advances are likely to help to customize and enhance the quality of care we provide to patients with TMJ disorders.
    Journal of dental education 09/2008; 72(8):930-47. · 0.97 Impact Factor
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    ABSTRACT: With cone beam CT (CBCT) as the reference standard, the objective of this study was to determine the diagnostic accuracy of MRI for assessing osseous abnormalities of the temporomandibular joint (TMJ). 106 TMJs from 55 patients with temporomandibular disorder were examined by CBCT and MRI. CBCT images were evaluated by two experienced oral radiologists with regard to the presence or absence of each of the following eight types of osseous abnormalities: Type 1, destructive and erosive osseous changes of the condyle; Type 2, flattening of the articular surface of the condyle; Type 3, deformity of the condyle; Type 4, sclerosis of the condyle; Type 5, osteophyte formation; Type 6, ankylosis; Type 7, erosion of the articular fossa and/or eminence; and Type 8, sclerosis of the articular fossa and/or eminence. For detection of these osseous abnormalities by MRI, proton density-weighted images and T(2) weighted images were evaluated independently by three observers. Using CBCT findings as the reference standard, the diagnostic performance of MRI for detecting various types of osseous abnormalities was evaluated by calculating its sensitivity and specificity. Out of 106 joints, CBCT revealed Types 1, 2, 3, 4, 5, 6, 7 and 8 abnormalities in 25, 19, 26, 20, 14, 5, 19 and 22 joints, respectively. The mean sensitivities of MRI among the three observers for detecting Types 1, 2, 3, 4, 5, 6, 7 and 8 abnormalities were 61%, 30%, 82%, 40%, 48%, 34%, 61% and 41%, respectively, whereas the mean specificities were 86%, 92%, 91%, 95%, 84%, 98%, 89% and 91%, respectively. Although high specificity (84-98%) was obtained with MRI, this modality showed relatively low sensitivity (30-82%) for detecting osseous abnormalities of the TMJ. The value of MRI for the detection of TMJ osseous abnormalities is considered to be limited.
    Dentomaxillofacial Radiology 07/2010; 39(5):270-6. DOI:10.1259/dmfr/25151578 · 1.39 Impact Factor
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