A retrospective study on the relationship between aging and tomographic findings in 174 patients with TMD

The purpose of this study was to examine age-related changes in the tomographic characteristics of the temporomandibular joints (TMJ) of patients with temporomandibular dysfunction (TMD). 174 patietns with TMD from 12–76 years old were divided into six groups by age. Bilateral TMJs of the patients were examined by TMJ tomography, and 91 joints were also performed with arthrography. The frequencies of abnormal condylar shape and osseous changes (including osteosclerosis, flattening, bone erosion and osteophytes) increased with age (P<0.01), less osseous changes were observed in the younger patients (<30 years) with anterior disk displacement with reduction than in the older ones (≥30 years) (P<0.05). No statistically significant difference in the frequency of condylar displacement was found among the groups. It was concluded that the frequencies of abnormal condylar shape and some osseous changes might increase with aging, which might be due to remodeling in TMJ and low adaptive ability of the TMJs in elderly people.     

The evaluation of temporomandibular joint disc position in TMJ disorders using MRI

The purpose of this study was to correlate disc position and the type of disc displacement, intra-capsular effusion and degenerative changes of the condyle as demonstrated in MRI studies. In this study, 126 temporomandibular joints (TMJs) of 63 patients with TMJ disorders were investigated using clinical examination and MRI. One hundred and twelve TMJs were found to have internal derangement as disc displacement. The angle between the posterior margin of the disc and the vertical line drawn through the centre of the condyle was measured on MRI for each TMJ. The positions of the discs were normal, 0 degrees-10 degrees, in 11.11%; slightly displaced, 11 degrees-30 degrees, in 37.30%; mildly displaced 31 degrees-50 degrees, in 15.08%; moderately displaced, 51 degrees-80 degrees, in 7.14% of the TMJs with anterior displacement with reduction (ADDR). The disc position was severely displaced anteriorly, as over 80 degrees, in all TMJs with anterior disc displacement without reduction (ADD), constituting 27.78% of all cases. We found that the smaller the degree of disc displacement the milder the internal derangement and that the intra-capsular effusion was more frequently associated with TMJ with ADDR. The degenerative condylar changes were more severe with an increased degree of anterior disc displacement.     

Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle

The aim of this study was to investigate temporomandibular joint (TMJ) pain and magnetic resonance imaging characteristics in 104 TMJs with and 58 without degenerative changes of the condyle, such as osteophytes, erosion, avascular necrosis, subcondral cyst and intra-articular loose bodies. TMJ images were also assessed for flattening, retropositioning and hypomobility of condyle and disc displacement. Comparison of the TMJ side-related data showed a significant relationship between disc displacement without reduction (DDwoR) and the presence of degenerative bony changes (p=0.00). Flattening, retropositioning and hypomobility of condyle showed no significant difference in relation to the presence or absence of degenerative bony changes. Retropositioning of the condyle was significantly associated to disc displacement with reduction (DDwR) (p=0.00), while condylar hypomobility was significantly more frequent in TMJ with DDwoR (p<0.05). Independent of the presence or type of DD, TMJ pain was more frequent in the presence of degenerative bony changes. When considering only DDwR, TMJ pain was significantly associated to a degenerative condition (p=0.03). When there were no degenerative bony changes, TMJ pain was significantly more frequent in DDwoR (p=0.04). Despite the present findings, the absence of symptoms in some patients with condylar bony changes suggests that the diagnosis of osteoarthritis should be established by evaluation of magnetic resonance images in association with clinical examination.     

The efficacy of anterior repositioning splint therapy studied by magnetic resonance imaging

Magnetic resonance images (MRIs) were obtained of 52 temporomandibular joints (TMJs) of 30 patients with TMJ disease, before insertion of an anterior repositioning splint. Ten TMJs showed a normal disc-condyle relationship. Pathological findings were partial or complete anterior disc displacement with disc reduction (n = 18), without (n = 7), or with partial reduction (n = 4) or non-reducing joints combined with osteoarthrosis (n = 13). Associated clinical findings were joint clicking, painful TMJ movements with or without condyle limitation, deviation, or crepitus. The clinical evaluation when compared with the MRIs correlated in 75 per cent of cases. Immediate post-insertion MRIs showed recapture of discs with a protrusive splint in 15 out of 18 reducing displacements. Recapture of the disc was seen in only two out of four joints with anterior disc displacement with partial disc reduction. There was no recapture in non-reducing joints. In severe cases of internal derangement with a wide range of disc displacement combined with changes of the osseous joint surfaces, the recapturing of the articular disc with an anterior repositioning appliance was unsuccessful (0 of 13). The follow-up for pain relief after one week showed a significant reduction of symptoms, despite the fact that recapture of the dislocated disc occurred in only 17 of the 42 pathological TMJs. The possibility for disc recapture depends on the disc-condyle position and configuration, the integrity of the posterior attachment, and the degree of degenerative changes of the intra-articular structures, such as osteophytosis, condylar erosion, or flattening of the articular disc. This diagnostic information influences the method of treatment of TMJ disorders. In non-reducing joints or in the later stages of internal derangement of the TMJ, it is not possible to achieve a normal disc-condyle relationship using protrusive splints.     

Arthrographic findings in the temporomandibular joint in patients with rheumatic disease

Hypocycloidal multisection tomography and lower-space arthrotomography with videofluoroscopy were performed on 20 symptomatic temporomandibular joints (TMJs) of 17 patients. All patients (16 women, one man, aged 17 to 38 years) had definite or suspected rheumatoid arthritis (adult or juvenile type), ankylosing spondylitis, or psoriatic arthropathy. Bone abnormalities were found in 14 TMJs, primarily cortical erosion (11 joints), but also condylar flattening (three joints). Irregularity in outline of the contrast material, bone contour-contrast material gaps, evidence of adherent discs and/or small joint compartments indicated synovial hyperplasia/pannus formation in 15 joints. Six of these (four with normal disc position) showed perforation between the joint compartments. In those with normal disc position the perforation seemed to occur in the central portion. Ten of the 15 joints had normal disc position; the remaining five had anterior disc displacement without reduction. One joint showed only disc displacement. Most joints with bone abnormalities (12 of 14) showed arthrographic signs of rheumatic involvement. Such signs were also observed in two of the six joints with no bone abnormalities, indicating the value of arthrography in the early diagnosis of patients with rheumatic disease and TMJ problems.     

Relationship between Degenerative Bone Changes of Condylar Surface and Articular Disc Disorders in Symptomatic Osteoarthrosis of Temporomandibular Joints

Purpose: We investigate the relation of bone changes of the condylar surface to disc displacement and discuss the development of joint symptoms in osteoarthrosis of temporomandibular (TM) joints.Subjects and Methods: Seventy-seven patients with an image diagnosis of degenerative bone changes of the unilateral condylar surface accompanied with joint symptoms were studied. The bone changes were assessed by panoramic radiographs and classified into two groups: pathologic bone changes (PBC) including erosion, osteophyte and deformity, and adaptive bone changes (ABC) including flattening and concavity. Magnetic resonance imaging was performed on the subjective TM joints to examine the configuration and position of articular discs. A visual analogue scale was used for evaluation of joint pain.Results: Erosion and deformity showed significantly higher prevalence than the other three kinds of bone changes in the joints with anterior disc displacement without reduction (ADWoR) as compared to those with anterior disc displacement with reduction (ADWR). The cases with the vertical disc position to the condyle ranging from 60° to less than 150° were more frequent than those ranging from 0° to less than 60° in the PBC group, whereas the cases with the vertical disc position to the condyle ranging from 0° to less than 60° were more frequent than those ranging from 60° to less than 150° in the ABC group. The average degree of joint pain when chewing but not jaw opening was higher in the joints with ADWoR than in those with ADWR, and in the PBC group than in the ABC group.Conclusion: The bone changes of the condylar surface diagnosed as PBC tended to induce more advanced disc displacement and chewing pain than those diagnosed as ABC.     

Association between disk position and degenerative bone changes of the temporomandibular joints: an imaging study in subjects with TMD

The aim of this study was to determine the frequency and relationship between disk position and degenerative bone changes in the temporomandibular joints (TMJ), in subjects with internal derangement (ID). MRI and CT scans of 180 subjects with temporomandibular disorders (TMD) were studied. Different image parameters or characteristics were observed, such as disk position, joint effusion, condyle movement, degenerative bone changes (flattened, cortical erosions and irregularities), osteophytes, subchondral cysts and idiopathic condyle resorption. The present study concluded that there is a significant association between disk displacement without reduction and degenerative bone changes in patients with TMD. The study also found a high probability of degenerative bone changes when disk displacement without reduction is present. No association was found between TMD and condyle range of motion, joint effusion and/or degenerative bone changes. The following were the most frequent morphological changes observed: flattening of the anterior surface of the condyle; followed by erosions and irregularities of the joint surfaces; flattening of the articular surface of the temporal eminence, subchondral cysts, osteophytes; and idiopathic condyle resorption, in decreasing order.     

The relationship between bone marrow edema and bone changes in the mandibular condyle: A longitudinal study with MR imaging

PurposeDecreased signal intensity on T1- or proton-density weighted magnetic resonance imaging (MRI) and increased signal intensity on T2-weighted MRI in the bone marrow space are thought to reflect bone marrow edema (BME). The purpose of this study was to determine whether condyle BME is associated with condyle bone changes.MethodsThe subjects were 57 patients [65 temporomandibular joints (TMJs)] with TMJ disorders showing condyle BME on initial MRI. Condyle bone changes were compared between TMJs that showed a persistent BME pattern (group P, 43 TMJs in 40 patients) and those that showed normal bone marrow signals, indicating disappearance of BME (group D, 21 TMJs in 22 patients) on follow-up MRI.Results(1) In TMJs with a condyle with a normal shape on initial MRI, condyle bone changes were present in 53.9% of TMJs in group P in follow-up MRI, whereas the normally shaped condyle remained in all TMJs in group D. (2) In TMJs with condyle erosion on initial MRI, condyle erosion was also present in 35.7% of TMJs in group P in follow-up MRI, but had disappeared in all TMJs in group D. (3) In TMJs with condyle osteophytes on initial MRI, erosion was present in 22.2% of TMJs in group P, whereas osteophytes remained in all TMJs in group D.ConclusionsThe longitudinal study showed that condyle BME is associated with condyle bone changes and may cause condyle erosion.     

Condylar erosion and disc displacement: detection with high-resolution ultrasonography.

PURPOSE: Our goal was to determine the feasibility of high-resolution sonography for the detection of condylar erosion and associated disc displacement at the temporomandibular joint (TMJ) condyle. MATERIALS AND METHODS: Forty-eight consecutive patients (96 joints) with TMJ disorders were investigated prospectively using a 12.5-MHz array transducer. Images were assessed for condylar erosion and disc displacements. Sonographic findings were correlated with those of magnetic resonance imaging (MRI). RESULTS: At MRI, 18 osseous changes were diagnosed with condylar erosion. Sonographically, 15 of the 18 condylar erosions were diagnosed correctly. Sensitivity, specificity, and accuracy of sonography in the depiction of condylar erosion were 83%, 63%, and 67%, respectively. The positive predictive value was 34%, and the negative predictive value was 94%. Disc displacement without reduction (43 of 96) and disc displacement without reduction concomitant with condylar erosion (16 of 96) were detected with an accuracy of 93% and 80%. CONCLUSION: Sonography is an insufficient imaging technique for the detection of condylar erosion. Assessment of disc displacement without reduction may be reliably made with sonography.     

Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup of degenerative joint disease

Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) as compared with the magnetic resonance imaging (MRI) 'gold standard'. The TMJ DJD group comprised 48 joints in 24 consecutive patients who were assigned a clinical bilateral diagnosis of TMJ DJD. The TMJ non-DJD group consisted of 82 joints in 41 consecutive patients without a TMJ-related diagnosis of TMD. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of degenerative joint changes. An MRI diagnosis of osteoarthrosis (OA) was defined by the presence of flattening, subchondral sclerosis, surface irregularities, and erosion of the condyle or presence of condylar deformities associated with flattening, subchondral sclerosis, surface irregularities, erosion and osteophyte. For the CDC/TMD interpretations, the positive predictive of DJD for OA was 67%, and for the presence of degenerative joint changes 88%. The overall diagnostic agreement for DJD was 44.6% with a corresponding K-value of 0.01. Most of the disagreement was due to false-negative interpretations of asymptomatic joints. The results suggest CDC/TMD to be predictive for degenerative joint changes but insufficient for determination of OA. Patients assigned a clinical TMJ-related diagnosis of DJD may need to be supplemented by evidence from MRI to determine the presence or absence of OA.     

Radiographic signs in the temporomandibular and hand joints in patients with psoriatic arthritis

The temporomandibular (TMJ) and hand joints of 64 patients with psoriatic arthritis (PA) were examined radiographically with panoramic tomography and dorsovolar projection. The associations between radiographic signs in the condyle of the TMJ and finger joints were analyzed with Pearson's product-moment correlation coefficient. Twenty-six patients (41%) had radiographic signs in their TMJs. Arthritic signs were seen in 14 (22%) and degenerative signs in 12 (19%) patients. Fifty-five patients (86%) had radiographic signs in their hands; 33 patients (52%) had arthritic and 22 (34%) degenerative signs. In the TMJ statistically significant correlations were found among erosion, flattening, and cortical sclerosis and also between osteophyte and cortical sclerosis. In the finger joints erosion correlated significantly with dislocation and loss of space. Erosion in the condyle of the TMJ was the only sign that correlated with changes in the finger joints such as erosion, dislocation, and ankylosis. Erosion in the TMJ also correlated with erosion in the metacarpophalangeal joint and wrist.     

Increased horizontal angle of the mandibular condyle in abnormal temporomandibular joints. A magnetic resonance imaging study

The horizontal condylar angle was measured in axial magnetic resonance images of normal and abnormal temporomandibular joints (TMJs). The average condylar angle in the normal joints was 21.2 degrees. In joints with disk displacement with reduction it was 29.7 degrees; joints with disk displacement without reduction, 33.5 degrees; and in joints with degenerative joint disease, 36.5 degrees. There were statistically significant differences between all four groups. Thus the condylar angle seemed to be increasingly larger with more advanced pathologic changes related to internal derangement and degenerative disease in the joint. The reason for the larger condylar angle in the abnormal joint was unclear. Joints with a larger condylar angle might have a greater tendency for internal derangement and degenerative joint disease to develop. Another possible explanation could be that remodeling associated with internal derangement and degenerative joint disease might result in a larger condylar angle. Further studies with longitudinal observations are needed to determine whether a causal relationship exists between the changes of the joint and a large condylar angle.     

Correlation of different MRI characteristics of anterior disc displacement with reduction and without reduction

The aim of this study was to evaluate the correlations between magnetic resonance imaging (MRI) findings in anterior displacement with reduction (ADDR) and anterior displacement without reduction (ADDWR). Two hundred patients with temporomandibular disorder (TMD) symptoms were examined clinically by a clinician experienced with this disorder. There were 130 joints with ADDR and 45 joints with ADDWR; 88 patients were identified according to the clinical and MRI diagnoses of both observers. The MRI characteristics such as position, signal intensity, morphology of disc, degenerative changes, effusion, scar tissue, avascular necrosis, and condylar hypermobility were evaluated in the individual with ADDR and ADDWR. The Chi-square test was used to determine the correlation between MRI characteristics in the ADDR and the ADDWR. There were significant relationships between degenerative changes and increased signal intensity, degenerative changes and side-way displacement, effusion and the deformation of the disc, effusion and subluxation, increased signal intensity and subluxation, elongation deformation and increased signal intensity, and elongation deformation and side-way displacement in ADDR. There were significant relationships between degenerative changes and effusion, degenerative changes and decreased signal intensity, scar tissue and avascular necrosis, deformation of disc and increased signal intensity, as well as deformation of disc and decreased signal intensity in ADDWR. These MRI findings also correlated with the clinical findings, however, this correlation appears to be a synergistic pattern rather than a set of clear-cut relationships. The correlations between these MRIs and different clinical findings such as pain and dysfunction also must be evaluated. Existing correlations must be considered in the diagnosis and treatment planning of TMD, and signs and symptoms of TMD should be monitored after treatment.     

A comparative study of axial corrected tomography with magnetic resonance imagery in 35 joints

Axially corrected tomographic examination of 35 temporomandibular joints was compared with respective MRI images. The criteria of joint space measurements, condylar positioning, and degenerative osseous changes were correlated with the MRI image of disk positioning. Joints with disk displacements that reduced with condylar translation and joints with disk dislocation without reduction of the articular disk were compared with normal examinations. The mean measured joint space on tomographic examination decreased with MRI evidence of disk displacement and dislocation. Fourteen of twenty-five joints with MRI documentation of disk displacement or dislocation did show a tendency for some condylar displacement from a centric position. Only the joints with MRI evidence of total disk dislocation showed bony evidence of degenerative changes with tomography. The clinical cross-sectional study suggests that there can be changes seen in axially corrected tomographic examinations that may suggest the presence of disk displacement or significant internal derangement.     

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??Objective??To evaluate the stability of disc position and condylar status by magnetic resonance imaging ??MRI??after temporomandibular joint ??TMJ??disc repositioning surgery with miniscrew anchor technique. Methods??Totally 150 cases of patients diagnosed with anterior disc displacement ??ADD??who received disc repositioning ??210 joints??were selected from February 2009 to July 2017 in the Department of Oral Surgery??Ninth People’s Hospital??Shanghai Jiao Tong University School of Medicine. MRIs within 1 week after operation and during at least 1 year follow-up were used to evaluate changes in the disc position and condylar bone. During follow-up??ADD without reduction was considered relapse and the bone status was classified as regeneration or degeneration. Results??Postoperative MRIs showed that all the discs were repositioned. During 12 to 96 months of follow-up ??averaged 26.73 months????95.71%??201/210?? of the discs  were still in position??whereas 5.71%??12/210?? of the discs  had relapsed anteriorly. Condylar new bone formation was observed in 77.62% ??163/210?? of the joints??no bone change in 20.48% ??43/210?? of the joints??and bone resorption in 1.90% ??4/210?? of the joints. Conclusion??TMJ disc repositioning by miniscrew anchor provides an effective means for the treatment of anterior disc displacement with stable result. Disc repositioin can also stimulate condylar bone regeneration.     

关节盘复位锚固术术后稳定性的影像学评价

目的　通过MRI评价颞下颌关节盘复位锚固术术后稳定性及髁突的改建情况。方法　选择2009年2月至2017年7月在上海交通大学医学院附属第九人民医院口腔外科行关节盘复位锚固术的150例颞下颌关节盘前移位（anterior disc displacement,ADD）患者（210侧关节）。经术后1周和至少1年MRI随访,评估关节盘的位置和髁突骨质变化。随访期间若出现不可复性ADD,则认为术后复发,根据骨质状态,将髁突改变分为再生或吸收。结果　术后1周MRI显示所有移位关节盘均复位。经12～96个月（平均26.73 个月）的随访,MRI显示95.71%（201/210）的关节盘位置良好,而5.71%（12/210）的关节盘前移复发。77.62%（163/210）的髁突有新骨形成,20.48%（43/210）的髁突无骨质变化,1.90%（4/210）的髁突发生骨吸收。结论　关节盘复位锚固术是治疗ADD的有效手段,盘复位位置稳定,并能刺激髁突骨再生。     

Evaluation of disc position in edentulous patients with complete dentures

OBJECTIVE: This study evaluated the condyle-disc relationship on magnetic resonance image (MRI) in a group of subjects with silent temporomandibular joints (TMJs) when tested clinically with those in subjects with discernible temporomandibular sounds.Study design Twenty-five completely edentulous patients were selected to participate in this study. The study was based on bilateral MRIs of 15 patients (with articular sound) and 10 symptom-free volunteers (control). RESULTS: It was noted that disc displacement was found in 45% of the TMJs with no history of articular sounds. In 6 TMJs of control group, a reducing disc displacement was found, and in 3 TMJs a permanent displacement was found. Disc displacements were identified in 70% of patients. Reducing disc displacement was found in 19 of these TMJs, whereas permanent displacement was found in 2 TMJs. In 9 of the joints of the symptomatic group, a superior disc position was found. Also verified was a significant association between reducing disc displacement and biconvex disc. CONCLUSION: These observations demonstrated that internal derangements can not be associated to clicking joints or symptoms of temporomandibular disorders in elderly edentulous patients, and the presence of displaced discs seems to be associated to altered disc morphology, but not to osseous abnormalities.     

颞下颌关节盘前移位和穿孔的关节内窥镜研究

目的 :探讨颞下颌关节内窥镜下颞下颌关节盘移位和关节盘穿孔的病理改变特征。方法 :76例 84侧临床诊断为颞下颌关节盘前移位以及关节盘穿孔的病例进行颞下颌关节内窥镜检查。结果 :可复性关节盘前移位的病例出现滑膜炎 ,关节腔内有絮状物 ,关节结节表面有纤维形成。不可复性关节结节表面纤维形成 ,关节软骨软化 ,软骨剥脱 ,同时伴有纤维粘连。关节盘穿孔大多数位于双板区与后带。关节盘穿孔出现滑膜增生 ,关节窝及关节结节表面纤维形成 ,软骨剥脱甚至骨质暴露。结论 :关节内窥镜检查可诊断关节盘前移位与关节盘穿孔 ,并能发现病理性改变 ,如滑膜炎 ,滑膜增生 ,纤维变性 ,软骨软化 ,关节内粘连等。在不可复性盘前移位病例中发现关节退行性改变 ,关节盘穿孔为严重的骨关节病。     

兔颞下颌关节盘移位与骨关节病关系的评价

目的评价颞下颌关节盘移位与骨关节病的关系。方法通过手术方法将２５只大耳白兔的颞下颌关节盘前移，术后１、２、４、８、１２周进行组织病理学检查。结果１１侧手术关节为部分关节盘前移位，８侧为完全性关节盘前移位，６侧为关节盘穿孔。部分关节盘前移位出现早期退行性改变和后期生理性改建，完全性关节盘前移位和关节盘穿孔出现退行性改变和严重的骨关节病。结论颞下颌关节盘前移位的程度与骨关节病有关，关节盘前移位越明显，越易出现骨关节病     

Prevalence of degenerative disease in temporomandibular disorder patients with disc displacement: A systematic review and meta-analysis

To assess the available literature on the prevalence of degenerative joint disease (DJD) in patients with anterior disc displacement (ADD) of the temporomandibular joint (TMJ), using a systematic review with meta-analysis.Search strategies were performed in the following databases: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, and LIVIVO. A search was also carried out in the gray literature. Two independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. Three reviewers independently collected the required information from the included articles. The methodological quality of the selected studies was assessed individually.In accordance with the inclusion and exclusion criteria, 1349 studies were found and 18 articles were included. The total sample size was 3158 TMJs. The sex distribution was predominant for females (1161 females and 345 males). The average age was 46 (range 10–82) years. Among the 1762 TMJs quantitatively assessed, the prevalence of DJD involving disc displacement with reduction (DDWR) was 35%, while for disc displacement without reduction (DDWoR) the prevalence was 66%. The prevalences of different features of DJD were as follows: sclerosis 24.3%, erosion 23.5%, osteophyte 17.9%, and subcortical cyst 7.6%.The prevalence of DJD in temporomandibular disorder patients with disc displacement is around 50% and is higher in DDWoR (66%) than in DDWR (35%). Sclerosis and erosion would be the most expected radiological signs in a developing DJD. Clinicians should adequately address the frequent DJD features associated with disc displacement in terms of diagnostics and therapeutic management.