Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis

doi:10.1016/j.oooo.2016.11.005

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Volume 123, Issue 3, March 2017, Pages 382-391

https://doi.org/10.1016/j.oooo.2016.11.005 Get rights and content

Objectives

The aim of this study was to evaluate changes in the trabecular structure of the mandibular condyle in patients with temporomandibular disorders (TMDs) using fractal analysis.

Study Design

A total of 100 patients ages 18 to 73 years were clinically assessed using the Diagnostic Criteria for Temporomandibular Disorders. The control group was age- and sex-matched with the patient group. Panoramic radiographs were obtained using a Kodak 8000 digital device with 73 kVp and 5 mA fixed parameters. The degree of degeneration in the mandibular condyles was calculated. Regions of interest (84 × 84 pixels) were selected within the cortical boundary of the mandibular condyle, and the fractal dimension (FD) was calculated using ImageJ version 1.48.

Results

Radiographic degenerative changes were more frequently present and more severe in the patient group (P < .001). The mean value of FD was 1.22 ± 0.06 in the patient group and 1.25 ± 0.06 in the control group (P = .001). A significant decrease in FD was observed (P = .001) in the left temporomandibular joints of the patient group, whereas a nonsignificant decrease in FD was observed in the right temporomandibular joints (P = .073) as degenerative changes increased.

Conclusions

Lower FD values were associated with more severe degenerative changes in the patient group. The trabecular structure of condyles in patients with TMD exhibited decreased complexity when erosive and sclerotic changes were evident. As a result, fractal analysis enhanced the use of panoramic radiography in detecting degenerative changes in patients with TMD.

Section snippets

Materials and Methods

The clinical protocol was approved by the Human Research Ethics Committee of the Istanbul University Faculty of Dentistry (protocol 2014/10). The study group comprised patients who were referred to the Istanbul University Faculty of Dentistry Dentomaxillofacial Radiology Clinic because of TMJ symptoms. This group included 100 patients with TMD aged 18 to 72 years who were randomly chosen among systemically healthy patients. None of the study patients had conditions that affected bone

Results

The study group comprised 100 patients, of whom 69 were women and 31 were men. The mean age of the study group was 31.52 years. The study group had significantly lower fractal dimension values (1.22 ± 0.06) than the control group (1.25 ± 0.06) (t₍₁₉₈₎ = 3.328; P = .001).

Table I presents the frequency, types, and severity of degenerative changes in both groups. In the study group, the most commonly observed degenerative change was flattening (175 joints, 87.5%), followed by erosion (71 joints,

Discussion

Several studies have demonstrated that fractal analysis is capable of showing changes in the structure of trabecular bone in patients with osteoporosis, hyperparathyroidism, and sickle cell anemia. In these studies, the differences between the healthy control and patient groups' fractal dimension values of trabecular bone were associated with changes in trabecular bone architecture and density.10, 13, 15, 16, 17, 22 In the field of dentistry, fractal analysis has been used to demonstrate the

Conclusion

We calculated the amount of degenerative change on mandibular condyles using fractal analysis and found that fractal dimensions of mandibular condyles of patients with TMD were decreased when more severe degenerative changes were present. The trabecular structure of condyles in patients with TMD is altered in such a way that lower fractal dimension values represent decreased complexity, which represents erosive and sclerotic changes. Furthermore, fractal analysis revealed changes in the

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With the acceleration of the aging process of the population, the number of edentulous patients continuously increased. Edentulism induces the loss of occlusal relationship and cause adverse effects on the stomatognathic system. Temporomandibular joint (TMJ), as a significant component of this system, may also be affected by edentulism in the process of supporting mandibular movement.
Provide a comprehensive review of the structure and function of TMJ in the edentulous population, as well as the prevalence of temporomandibular joint disorder (TMD) in edentulous group.
An electronic search was conducted on articles prior to December 2022 to filter all papers relevant to the structure and function of TMJ in edentulous population. The internet databases (PubMed, Cochrane Library, Embase) were searched using various combinations of keywords for “edentulism” or “edentulous” and “TMJ” or “TMD”.
Firstly, 522 articles were selected from the internet database, and finally, a total of 44 articles met the inclusion and exclusion criteria. The research content of these articles mainly focuses on the structure and function of TMJ in edentulous patients, as well as the clinical signs and symptoms of TMD.
Edentulous arch induces the loss of occlusal relationship, which may lead to degenerative changes of TMJ components consisting of changes in morphology and bone mass density of condyle, articular fossa, and articular eminence. In addition, the condyle could be shifted backward and upward, and displacement of the articular disc may occur after dentition loss. And the condyle and the articular disc may be guided back to the normal position after effective prosthodontic treatment. But the conclusions of the study on the function of TMJ and the prevalence of TMD in edentulous people are inconsistent. The condition of TMJ, especially the position of condyle-fossa and the symptoms and signs of TMD should not be ignored. If necessary, radiographic examinations should be performed.
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Temporomandibular disorder (TMD) is still a challenge in terms of diagnosis and management. The aim of this study is to explore if the evaluation of salivary biomarkers and fractal dimension (FD) of mandibular condyle could be useful for interpreting early degenerative changes and the effectiveness of salivary cortisol in determining the stress levels of TMD patients.
34 patients with TMD, and 34 healthy controls were included in this study. Saliva samples were obtained from all participants between 09:00-12:00 am. Salivary cortisol, IL-1β, TNF-α, and MMP-3 levels were evaluated with ELISA method. FD of the mandibular condyle was determined by means of box-counting method. Depression and anxiety were determined with PHQ-9 and GAD-7 questionnaires.
The salivary cortisol and depression/anxiety were higher in study group; however, not significant (p>0.05). FD of the study group was found significantly lower than the control group (p<0.01). Salivary TNF-α, IL-1β and MMP-3 levels were showed no significant difference between the two groups (p>0.05). There were no significant correlations between the evaluated parameters.
Salivary cortisol seems to be a non-invasive way of measuring physiological stress of TMD patients. Fractal analysis may be a useful tool in detecting early structural changes in mandibular condyle. Salivary TNF-α. IL-1β and MMP-3 have not a diagnostic value in terms of interpreting early degenerative changes.
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Oral and maxillofacial radiologyAssessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis

Objectives

Study Design

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Conclusion

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Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis