Tomographic assessment of temporomandibular joint osseous articular surface contour and spatial relationships associated with disc displacement and disc length

doi:10.1067/mod.2002.120641

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 121, Issue 2, February 2002, Pages 152-161

https://doi.org/10.1067/mod.2002.120641 Get rights and content

Abstract

The objective of this retrospective study was to determine whether associations exist between osseous temporomandibular joint (TMJ) characteristics and TMJ internal derangement (disc position and deformation) in an adolescent population. Magnetic resonance imaging (MRI) was used to quantitatively determine disc position and length in 335 TMJs in 175 subjects (106 female and 69 male) between the ages of 7.27 and 20.0 years (mean age, 13.08 years). Nine tomographic variables were measured from pretreatment tomograms. Tomographic data were cross-referenced with MRI data. Male and female samples were evaluated separately. Stepwise linear regression identified associations between disc displacement and reduced superior joint space, increased posterior joint space, increased anterior joint space, and reduced articular eminence convexity (male R² value, 0.41; female R² value, 0.38). Associations between reduced disc length and condylar position and eminence flattening were weaker (male R² value, 0.16; female R² value, 0.32). This study demonstrates that TMJ internal derangement is associated with functional osseous adaptation within the joint. (Am J Orthod Dentofacial Orthop 2002;121:152-61)

Section snippets

Material and methods

Axially corrected tomographic radiographs and MRIs of 335 TMJs in 175 subjects (106 female and 69 male) between the ages of 7.27 and 20.0 years (mean age, 13.08 years) were used for this study. Mean male age was 13.02 years, and mean female age was 13.12 years. We recruited 128 consecutive subjects from orthodontic specialty offices regardless of TMJ signs or symptoms, and 47 others were referred with signs or symptoms of TMJ dysfunction. No one with a history of juvenile rheumatoid arthritis

Results

Results of the stepwise linear regression are given in Table II.

. Results of stepwise linear regression for independent variables for overall sample (n = 335) with dependent variables of disc displacement and disc length

Disc displacement	Empty Cell	Empty Cell	Disc length		Empty Cell
R²	0.42		R²	0.27
Overall regression	Coefficient	P value	Overall regression	Coefficient	P value
AJS	1.2283	<.0001	AJS	−0.4739	.0008
PJS	0.5692	.0015	PJS	−0.5955	.0005
SJS	−1.0779	<.0001	SJS	0.9244	<.0001
Central em. curvature	−2.6573	.0138	Central em. curvature	2.2639	.0285
Inferior

Discussion

The first objective of this study was to evaluate the contours of the load-bearing regions of the condyle and the articular eminence as they relate to the spectrum of disc displacement and disc shortening. The second objective was to evaluate TMJ osseous spatial relationships with the spectrum of disc displacement and disc shortening. Subjective classification of disc position has been reported as reliable in identifying complete disc displacement, but it is relatively weak in classifying

Conclusions

An examination of osseous morphology and spatial relationships in relation to disc displacement and disc length in an adolescent population revealed the following:

1.
As disc displacement increases, the convexity of the posterior slope of the articular eminence is reduced relative to the CLP.
2.
As disc length decreases, the convexity of the posterior slope of the articular eminence is reduced relative to the CLP.
3.
As disc displacement increases, SJS decreases, and AJS and PJS increase significantly.
4.
As

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This study investigated the association of computed tomography (CT)–verified degenerative condylar changes with disk displacement (DD) and sex.
Multidetector CT and cone beam CT scans of 165 condyles were evaluated for erosion, osteophyte formation, flattening, subcortical sclerosis, generalized sclerosis, subcortical defects, and loose joint bodies. Disk position was determined using magnetic resonance imaging. The association of degenerative alterations with disk position and sex was analyzed.
The risks of erosion, osteophyte formation, and flattening were significantly increased by 3.72, 9.00, and 6.35 times, respectively, in the joints with DD without reduction (DDNR); however, the risks of these changes did not increase significantly in joints with DD with reduction. The risks of extensive erosion and slight and moderate osteophyte formation significantly increased only in the joints with DDNR. The degenerative changes were more likely to exist together in the joints with DDNR than in those with a normal disk position. The association of DD and most degenerative morphologies was not significantly influenced by sex.
Erosion, osteophyte formation, and flattening were significantly associated with DDNR, regardless of sex.
CBCT evaluation of condylar changes in children with unilateral posterior crossbites and a functional shift
2019, Seminars in Orthodontics
Citation Excerpt :
Kinniburgh used MRI and tomograms to evaluate the condyles in normal patients and those with anteriorly displaced discs, and they found that the anterior joint space was 1.92 mm, the superior joint space was 3.62 mm, and the posterior joint space was 2.95 mm.33 Major, in 2002, used MRI and tomograms to study joint position and they found that osseous adaptations occur within the TMJ if internal derangements are present and that disc displacement is associated with a reduced joint space.34 Katsavrias and Halazonetis, in 2005, using axially corrected tomograms found that class III subjects had a more elongated and anteriorly inclined condylar head and a wider and more shallow fossa.
Posterior crossbite is one of the most frequently occurring malocclusions in adolescents with a prevalence of 7% to 23%. The most common form of posterior crossbite is a unilateral posterior crossbite with a functional side shift. It has been suggested that functional posterior crossbites (FUPXB) may result in right-to-left-side differences in the condyle fossa relationship, resulting in temporomandibular joint (TMJ) problems. The objective of this study was to determine if pathological position of the condyles can cause condylar signs or symptoms like degenerative joint disease (DJD) or juvenile condylar resorption (JCR), or if the position of the condyle is just an altered position within the TMJ. Sixty patients with an average age of 9.6years were randomly selected from the office of one of the investigators (T.S.). The study group consisted of 29 patients with a FUPXB and the control group had 31 patients with no posterior crossbite. All patients had multislice CT scans of the TMJ taken as part of the orthodontic records. Transverse widths were measured at the skeletal base and the dentoalveolar base. Molar inclinations, condylar angulations, condylar anterior joint space, superior joint space, and posterior joint space were measured. Independent sample t-tests were used to compare different measurements between groups and paired sample t-tests were used to compare differences within the same patient. Reliability of measurements were determined using pairwise correlation. For dentoalveolar measurements of transverse width, the maxillomandibular difference for the study group was -8.2 mm and for the control group was -4.0 mm. No significant differences were found between the molar inclinations, condylar width, angulation, or any joint space measurements between the two groups. A total of 61.3% of the subjects in the control group and 72.4% in the study group had a radiographic sign of joint disease. The lack of condylar positional differences between the control and crossbite groups suggests that TMJ signs and symptoms in the study group may be related to remodeling in the TMJ instead.
Association between condylar position and vertical skeletal craniofacial morphology: A cone beam computed tomography study
2017, International Orthodontics
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The complex structure of the TMJ makes visualization of the TMJ difficult, and hence various types of radiographic modalities are required for accurate radiographic examination of the joint [24]. Previously, various radiographic modalities have been proposed for evaluating condyle-fossa relationships including conventional radiographs [28], conventional tomography [22,29], computed tomography (CT) [30], CBCT [31–34] and magnetic resonance imaging (MRI) [35,36]. According to the American Dental Association (ADA), 2D radiography is not a reliable technique for evaluating condylar position [37].
Condylar position may play an important role in the establishment of different craniofacial morphologies. The aim of the present study was to determine the possible association between condylar position and vertical skeletal craniofacial morphology in subjects with normal sagittal skeletal pattern using CBCT.
The CBCT images of 45 patients with Class I sagittal skeletal pattern were classified into three balanced groups on the basis of SN-MP angle. Each group contained 15 subjects: low angle, normal angle and high angle. The condylar position was determined for the left and right joints. Chi square test was applied to assess the association between condylar position and vertical skeletal growth pattern.
The condyles were more anteriorly-positioned in patients with high angle vertical pattern than in those with normal and low angle vertical pattern. No significant differences were found in condylar position between low angle and normal angle subjects.
A significant correlation between condylar position and vertical skeletal pattern was found in the present study. This relationship can be considered for predicting and establishing a proper treatment plan for temporomandibular diseases during orthodontic treatment.
MRI alone versus MRI-CBCT registered images to evaluate temporomandibular joint internal derangement
2016, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
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It thus appears that regardless of the superiority of MRI as a modality for identifying soft tissue structures of the jaw joint, the above noted limitations hamper ideal interpretation of joint anatomy and provide an opportunity for improvement in joint imaging interpretation. It has been suggested that examiner consistency in MRI interpretation improved when using the functional position of the intermediate zone of the articular disc and well-defined criteria for classification of the disc-condyle relation.1,12,13,29-31 Examiner consistency in classifying disc position was found to improve when the new assessment method using MRI-CBCT image registration to visualize TMJ was recently introduced.18
To evaluate the effect of magnetic resonance imaging–cone beam computed tomography (MRI-CBCT) image registration on inter- and intraexaminer consistency when evaluating temporomandibular joint (TMJ) internal derangement compared to MRI alone.
MRI and CBCT images of 25 patients (50 TMJs) were obtained and coregistered using mutual-information rigid image registration via Mirada XD software. Two experienced radiologists independently and blindly evaluated two types of images (MRI alone and MRI-CBCT registered images) at two different times (T1 and T2) for TMJ internal derangement, based on sagittal and coronal articular disc position in relation to the head of the condyle and the posterior slope of the articular eminence.
The intraexaminer consistency with MRI alone (examiner 1 = 0.85 [0.74-0.92]; examiner 2 = 0.91 [0.84-0.95]) was lower than for the MRI-CBCT registered images (examiner 1 = 0.95 [0.91-0.97]; examiner 2 = 0.97 [0.96-0.99]). The interexaminer consistency of evaluating internal derangement with MRI alone (0.52 [0.18-0.73] at T1; 0.71 [0.45-0.84] at T2) was lower than for the MRI-CBCT registered images (0.97 [0.95-0.98] at T1; 0.98 [0.96-0.99] at T2). When disc position classification was dichotomized to normal versus anteriorly displaced, intraexaminer agreement for the two examiners was 0.52 and 0.63 for MRI alone, but was 0.91 and 0.92 for MRI-CBCT registered images. Interexaminer agreement for MRI alone was 0.29 at T1 and 0.42 at T2, but was 0.96 at both examination times for MRI-CBCT registered images.
The MRI-CBCT registered images improved intra- and interexaminer consistency in the evaluation of internal derangement of TMJ.
Non-joint effusion is associated with osteoarthritis in temporomandibular joints with disk displacement
2016, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
The condylar position, joint space, and depth of the eminence were determined according to Robinson de Senna et al. (2009), Major et al. (2002) and Almasan et al. (2013), respectively. The tilt of the eminence was measured by the angle formed by the posterior slope (Major et al., 2002) and the vertical line. In order to avoid misinterpretation, the sagittal and corresponding coronal images were evaluated at the same time.
The aim of this study was to examine the possible association between different grades of joint effusion (JE) and osteoarthritis (OA) in temporomandibular joint (TMJ) anterior disk displacement without reduction (ADDwoR).
A sample of 101 female patients 20–40 years of age with unilateral TMJ ADDwoR were retrospectively reviewed. JE and OA were diagnosed with magnetic resonance imaging (MRI). JE was subdivided into three different grades: grade 0, no or minimal effusion; grade 1, moderate effusion; and grade 2, extensive effusion. Eight categories of degenerative changes were used for screening for the existence of OA. Cases with no less than one type of degenerative change were diagnosed as OA.
In all, 71 patients (70.3%) were diagnosed as having OA in the joints with disk displacement. In the univariate analysis, the proportion of subjects with non-JE (grade 0) was higher in the OA group (p = 0.003), while the proportion of subjects with extensive effusion (grade 2) was lower in the OA group (p = 0.02). In the multivariate logistic regression analysis, non-JE was independently associated with the development of OA (odds ratio = 5.68, 95% confidence interval = 1.10–29.37, P = 0.04).
The results suggested that non-JE was associated with OA in the joints with ADDwoR.
Association between mandibular condylar position and clinical dysfunction index
2015, Journal of Cranio-Maxillofacial Surgery
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Tsuruta Akemi et al. suggested that condyles with morphological bony changes, especially osteophyte formation, were located more anteroinferiorly (Tsuruta et al., 2004). In the aforementioned studies (Major et al., 2002; Gateno et al., 2004; Mischkowski et al., 2007; Pereira et al., 2007; Vasconcelos et al., 2007; Huang and Zhang, 2012; Okur et al., 2012; Cho and Jung, 2012), the investigators compared patients with TMD to controls, whereas in the current study, patients with various degrees of TMD severity were compared among each other. To the best of our knowledge, the only study that was similar to the present research was the study of Savakkanava et al., who evaluated the association between TMD and condylar position in Davangere population in India (Savakkanava et al., 2012).
Condylar position in the glenoid fossa has been associated with temporomandibular disorders. The purpose of the present study was to investigate the correlation between clinical dysfunction index (Di) and mandibular condylar position in patients with temporomandibular joint dysfunction (TMD) using cone beam computed tomography (CBCT).
In this cross-sectional study, participants were recruited from the Department of Maxillofacial Radiology at Shiraz Dental University in Iran. The condylar position was assessed on the CBCT images of 120 temporomandibular joints in 60 patients with TMD. Patients were divided into 3 groups based on Helkimo's clinical Di. The chi-square test was used to correlate degree of the Helkimo's Di with the mandibular condylar position. The p value was set at 0.05.
A total of 60 patients (42 women and 18 men; mean age, 33.4 years) participated in this study. Significant differences in condylar position were found among the 3 groups (Di I, II, and III) (p < 0.05). Patients with mild to moderate TMD were found to have anteriorly and concentric seated condyles. Posteriorly seated condyles were found in patients with severe TMD.
Condylar position is associated with different severity of TMD.

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^*: ^bPrivate practice, Calgary.

^**: ^cResearch Associate, Orofacial Pain Clinic, Faculty of Medicine and Dentistry, University of Alberta, Edmonton.

^*: ^dAssociate Professor, Department of Mathematical Sciences, Faculty of Science, University of Alberta, Edmonton.

^**: ^eChairman, Division of Graduate Orthodontics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton.

^♢: Reprint requests to: Dr P. W. Major, Faculty of Medicine and Dentistry, Room 1043, Dentistry Pharmacy Center, University of Alberta, Edmonton, Alberta, Canada T6G 2N8; e-mail, [email protected].

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Original ArticleTomographic assessment of temporomandibular joint osseous articular surface contour and spatial relationships associated with disc displacement and disc length*,**,*,**,♢

Abstract

Section snippets

Material and methods

Results

Discussion

Conclusions

Am J Orthod Dentofacial Orthop

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Magn Reson Imaging

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

J Prosthet Dent

J Biomech

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

J Biomech

J Biomech

J Biomech

J Prosthet Dent

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

Original Article
Tomographic assessment of temporomandibular joint osseous articular surface contour and spatial relationships associated with disc displacement and disc length*,**,*,**,♢