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Deniz Y, Eren H, Sessiz R, Coşan Ata G. Comparison of CBCT radiation doses with conventional radiographs in TMJ imaging using Monte Carlo simulations. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:39-45. [PMID: 38182962 DOI: 10.1007/s00411-023-01057-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024]
Abstract
Three-dimensional imaging methods are widely used for evaluation of bony changes of temporomandibular joint (TMJ). Besides, lateral and posterio-anterior TMJ projections in both closed- and open-jaw positions for each temporomandibular joint are used as two-dimensional diagnostic tools. The purpose of the present study was to compare effective and mean organ absorbed doses of plain radiography techniques with those of different modalities of cone beam computed tomography (CBCT) scanning of an adult's temporomandibular joint. PCXMC 2.0 software was used to calculate mean organ and effective doses. A NewTom CBCT device (Newtom 5G XL; QR systems; Verona, Italy) was simulated at 360° rotation using a 6 × 6 cm2 FOV in standard and high-resolution modes. Lateral and posterio-anterior TMJ plain projections were simulated according to recommendations of the manufacturer of the Planmeca ProMax® 2D S3 device. Doses for both projections were simulated with Monte Carlo methods and the International Commission on radiological protection adult reference computational phantoms. The highest mean organ absorbed doses occurred in bone surfaces, salivary glands, and skull for posterio-anterior TMJ and lateral TMJ, and for CBCT scanning in all examinations. The effective doses of posterio-anterior and lateral TMJ plain radiographs were found to be higher than those of the Standard Mode-Eco Scan CBCT. Therefore, the lowest effective dose was calculated in Standard Mode-Eco Scan CBCT. It is concluded that NewTom 5G XL Standard Mode-Eco Scan CBCT can be used instead of plain radiographs (lateral and posterio-anterior TMJ) in temporomandibular joint imaging as it allows visualizing the three-dimensional structure of the temporomandibular joint as an advantage.
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Affiliation(s)
- Yeşim Deniz
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Çanakkale Onsekiz Mart University, Sahil Yolu Cad. No: 5, Kepez, Çanakkale, Turkey
| | - Hakan Eren
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Çanakkale Onsekiz Mart University, Sahil Yolu Cad. No: 5, Kepez, Çanakkale, Turkey.
| | - Rüya Sessiz
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Çanakkale Onsekiz Mart University, Sahil Yolu Cad. No: 5, Kepez, Çanakkale, Turkey
| | - Gamze Coşan Ata
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Çanakkale Onsekiz Mart University, Sahil Yolu Cad. No: 5, Kepez, Çanakkale, Turkey
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Schroder ÂGD, Gonçalves FM, Germiniani JDS, Schroder LD, Porporatti AL, Zeigelboim BS, de Araujo CM, Santos RS, Stechman-Neto J. Diagnosis of TMJ degenerative diseases by panoramic radiography: is it possible? A systematic review and meta-analysis. Clin Oral Investig 2023; 27:6395-6412. [PMID: 37821655 DOI: 10.1007/s00784-023-05293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The objective of this work was to determine the diagnostic accuracy of panoramic radiography in detecting degenerative diseases of the temporomandibular joint. METHOD The protocol was registered at the PROSPERO website. To consider the eligibility of studies to be included/excluded from this review, the acronym "PIRDS" was used and appropriate word combinations and truncations were adapted in the following electronic databases: PubMed/Medline, EMBASE, Latin American and Caribbean Literature on Health Sciences, Web of Science, Scopus, and Cochrane Library. RESULTS A total of 2572 references, after the removal of duplicates, were retrieved from the eight electronic databases. After reading the titles and abstracts, a total of 26 articles were selected for full reading, of which ten were excluded, resulting in 16 articles included for qualitative synthesis. All in vivo studies were classified as having a low risk of bias. Regarding in vitro studies none of the included studies scored below 80% in the overall evaluation. CONCLUSIONS Both in vitro and in vivo studies consistently report a low accuracy in detecting degenerative diseases of the temporomandibular joint using panoramic radiography. CLINICAL RELEVANCE Cone-beam computed tomography offers a superior image quality without overlapping structures and a higher accuracy compared to panoramic radiography. However, panoramic radiography can still serve as an initial examination when combined with a clinical assessment. CBCT should be reserved for cases where there are evident clinical and/or radiographic alterations that recommend its use. This approach ensures a judicious and cost-effective use of CBCT resources.
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Affiliation(s)
- Ângela Graciela Deliga Schroder
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, R. Padre Ladislau Kula, 395 - Santo Inácio-, Curitiba, PR, 82010-210, Brazil.
| | - Flávio Magno Gonçalves
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, R. Padre Ladislau Kula, 395 - Santo Inácio-, Curitiba, PR, 82010-210, Brazil
| | - Julia da Silva Germiniani
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, R. Padre Ladislau Kula, 395 - Santo Inácio-, Curitiba, PR, 82010-210, Brazil
| | | | - André Luiz Porporatti
- Laboratoire de Neurobiologie OroFaciale, Université de Paris, France and GHPS Assitance Publique Hopitaux, de Paris, France
| | - Bianca Simone Zeigelboim
- Post-graduate Program in Communication Disorders, University Tuiuti do Paraná, Curitiba, Paraná, Brazil
| | - Cristiano Miranda de Araujo
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, R. Padre Ladislau Kula, 395 - Santo Inácio-, Curitiba, PR, 82010-210, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, R. Padre Ladislau Kula, 395 - Santo Inácio-, Curitiba, PR, 82010-210, Brazil
| | - José Stechman-Neto
- Postgraduate Program in Communication Disorders, Tuiuti University of Paraná, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, R. Padre Ladislau Kula, 395 - Santo Inácio-, Curitiba, PR, 82010-210, Brazil
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Dhabale GS, Bhowate RR. Cone-Beam Computed Tomography for Temporomandibular Joint Imaging. Cureus 2022; 14:e31515. [DOI: 10.7759/cureus.31515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
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Yuan S, Liu Y, Deng K, Li X, Bakker AD, Klein-Nulend J, Pathak JL, Zhang Q, Wang Z. Correlation of clinical manifestations and condylar morphology of patients with temporomandibular degenerative joint diseases. Cranio 2022:1-8. [PMID: 34986737 DOI: 10.1080/08869634.2021.2018199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study the correlation between condylar morphology and clinical manifestations in patients with degenerative joint disease (DJD) of the temporomandibular joint (TMJ). METHODS A total of 175 joints of 131 patients with DJD were included. Data on patients' basic information and symptoms were collected and analyzed. Condylar morphology was evaluated using cone beam computed tomography (CBCT). The correlation between the condylar morphology and clinical manifestations was analyzed. RESULTS The prevalence of joint noises, clicks, and crepitus was 93/175 (53%), 73/175 (42%), and 20/175 (11%), respectively. Condylar anteroposterior diameter and condylar height were correlated with pain. There was a correlation between the shape of the condyle in the sagittal plane and joint noise. CONCLUSION Condylar morphology and clinical features of DJD were correlated to some extent.
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Affiliation(s)
- ShanShan Yuan
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Reasearch of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - YaRui Liu
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Reasearch of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - KaiTong Deng
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Reasearch of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - XingYang Li
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Reasearch of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Astrid D Bakker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Janak L Pathak
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Reasearch of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - QingBin Zhang
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Reasearch of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - ZhaoJian Wang
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Reasearch of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Tsai CM, Wu FY, Chai JW, Chen MH, Kao CT. The advantage of cone-beam computerized tomography over panoramic radiography and temporomandibular joint quadruple radiography in assessing temporomandibular joint osseous degenerative changes. J Dent Sci 2020; 15:153-162. [PMID: 32595895 PMCID: PMC7305453 DOI: 10.1016/j.jds.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/04/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND/PURPOSE The clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) is based primarily on radiographic features of the condyle and articular eminence. The purpose of this study was to compare the reliability, sensitivity, and specificity of using plain radiography to that of cone-beam computerized tomography (CBCT) in identifying different types of osseous degenerative features in the TMJ condyle. MATERIALS AND METHODS The panoramic radiography (PANO), TMJ quadruple radiography (TMJQR) and CBCT images of 29 patients' TMJs were retrieved from a computer database and independently evaluated by a young oral surgeon and a senior TMD specialist. The examiners diagnosed osseous degenerative features on the radiographic images. The radiologist-assisted CBCT diagnoses were used as a reference standard and the reliability, sensitivity, and specificity of using the three radiographic modalities were statistically analyzed. RESULTS There were cases of indeterminate diagnoses using the PANO and TMJQR due to superimposition from surrounding structures, but none using CBCT. Reliability was generally poor when using PANO and TMJQR for detecting osseous degenerative features of the TMJ condyle but good to excellent when using CBCT. The sensitivity and specificity in the use of PANO and TMJQR were typically below acceptable, but the levels were generally satisfactory when using CBCT. CONCLUSION CBCT is superior to plain radiographic modalities for diagnosing osseous degenerative features of TMJs with regard to indeterminate cases, reliability, sensitivity, and specificity. It is recommended that CBCT can be used as an effective tool in identifying TMJ osteoarthritis.
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Affiliation(s)
- Chih-Mong Tsai
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Fang-Yu Wu
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Mu-Hsiung Chen
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Ting Kao
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Ma RH, Li G, Sun Y, Meng JH, Zhao YP, Zhang H. Application of fused image in detecting abnormalities of temporomandibular joint. Dentomaxillofac Radiol 2018; 48:20180129. [PMID: 30495970 DOI: 10.1259/dmfr.20180129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES: To present a method for image fusion of cone beam CT (CBCT)/CT and MRI and to explore whether the image data sets fused in such a way could aid the detection of temporomandibular joint (TMJ) anatomical structures and lesions. METHODS: There were five cases included in this study. One case was space occupying lesion giant cell tumour of tendon sheaths, one case was chronic inflammation in the condyle, one case was articular disc calcification of the bilateral TMJs, and the other two cases were TMJ disorders (anterior disc displacement without reduction). The digital imaging and communications in medicine format data of CT/CBCT and MRI of the cases were collected, and then imported to the Amira visual software where the registration process was conducted. Based on the different scan model, the registration process could be separated into automatic registration of CT/CBCT with quadrature slice MR images and the semi-automatic registration of CT/CBCT with oblique slice MR images by altering the registration parameters. Rigid transform model and the similarity metric of normalization mutual information was used for registration in the present study. RESULTS: The relationship between the soft mass and hard tissue was shown clearly in the fused images when compared to sole observation of CBCT/CT or MR images. The fused images could define the tumour outline and the destructive bone clearly in the same image. The fused results helped the observers to ensure uncertain defects which could not be confirmed only by one image data set. CONCLUSIONS: The CT/CBCT and MR images could be fused to aid detection of TMJ anatomical structures and related lesions.
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Affiliation(s)
- Ruo-Han Ma
- 1 Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology , Beijing , China
| | - Gang Li
- 1 Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology , Beijing , China
| | - Yi Sun
- 2 Department of Imaging & Pathology, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium
| | - Juan-Hong Meng
- 3 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology , Beijing , China.,4 Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology , Beijing , China
| | - Yan-Ping Zhao
- 1 Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology , Beijing , China.,4 Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology , Beijing , China
| | - Hao Zhang
- 4 Center for Temporomandibular Disorders and Orofacial Pain, Peking University School and Hospital of Stomatology , Beijing , China.,5 Department of Prosthodontics, Peking University School and Hospital of Stomatology , Beijing , China
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Im YG, Lee JS, Park JI, Lim HS, Kim BG, Kim JH. Diagnostic accuracy and reliability of panoramic temporomandibular joint (TMJ) radiography to detect bony lesions in patients with TMJ osteoarthritis. J Dent Sci 2018; 13:396-404. [PMID: 30895151 PMCID: PMC6388822 DOI: 10.1016/j.jds.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background/purpose The value of the temporomandibular joint (TMJ) projections of panoramic radiography for diagnosing TMJ osteoarthritis is not completely elucidated. This study aimed to assess the diagnostic accuracy and reliability of panoramic TMJ radiography to detect bony lesions in patients with TMJ osteoarthritis. Materials and methods This study included 55 TMJs of 44 subjects who were diagnosed with TMJ osteoarthritis. They underwent panoramic radiography (PanRad), lateral (LatTMJ) and frontal (FrnTMJ) projection panoramic TMJ radiography, and cone-beam computed tomography (CBCT). All images were examined by two observers for flattening, erosion, and osteophytes on the condylar head and articular eminence of the TMJ. Results For detecting flattening lesions on the mandibular condyle, the sensitivities of PanRad, LatTMJ, and FrnTMJ were less than 67% and the combination of LatTMJ and FrnTMJ (ComTMJ) had the highest sensitivity for both observers (67.6% and 79.7%, respectively). For erosion lesions, the sensitivity of ComTMJ for observer 1 was the highest, at 84.3%, whereas the specificity of ComTMJ was the lowest, at 37.5%. The sensitivities of all four methods for observer 2 were less than 54% and the specificities ranged from 75.0% to 100%. The overall diagnostic accuracy was highest for ComTMJ (64.3%), followed by LatTMJ (59.5%). The intraobserver reliability was good for one observer and excellent for the other, and the interobserver reliability was fair or moderate. Conclusion Panoramic TMJ radiography demonstrated limited diagnostic accuracy and acceptable reliability in detecting bony lesions of the TMJ, although it was better than conventional panoramic radiography.
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Affiliation(s)
- Yeong-Gwan Im
- Department of Oral Medicine, Chonnam National University Dental Hospital, Gwangju, Republic of Korea
| | - Jae-Seo Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea
| | - Ji-Il Park
- Department of Dental Hygiene, Gwangju Health University, Gwangju, Republic of Korea
| | - Hae-Soon Lim
- Department of Dental Education, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea
| | - Byung-Gook Kim
- Department of Oral Medicine, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea
| | - Jae-Hyung Kim
- Department of Oral Medicine, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea
- Corresponding author. Department of Oral Medicine, School of Dentistry, Chonnam National University, 33, Yongbong-ro, Buk-gu, Gwangju, 61186, Republic of Korea. Fax: +82 62 530 5679.
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Comparative cone-beam computed tomography evaluation of the osseous morphology of the temporomandibular joint in temporomandibular dysfunction patients and asymptomatic individuals. Oral Radiol 2017; 34:31-39. [DOI: 10.1007/s11282-017-0279-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/21/2017] [Indexed: 11/25/2022]
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9
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de Almeida Giunco JS, Oltramari-Navarro PVP, Fernandes TMF, de Lima Navarro R, de Almeida MR, de Castro Ferreira Conti AC. Assessment of Interexaminer Agreement in the Detection of Condyle Morphology and positioning with Two Methods: Radiographic and Tomographic. J Contemp Dent Pract 2016; 17:837-843. [PMID: 27794155 DOI: 10.5005/jp-journals-10024-1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM This study aims at evaluating the interexaminer agreement between radiographic and tomographic methods to determine condyle morphological variations and positioning. MATERIALS AND METHODS The sample comprised 100 individuals aged 13 to 30 years, from the patient files of University of North Paraná. The assessment of condyles morphology and positioning was performed in images of digital panoramic radiography (DPR) and reconstructed panoramic images from the cone beam computed tomography (CBCT) scans, by using the Dolphin three-dimensional (3D) program. The condyle morphology was categorized as flat, convex, and angular as well as its positioning classified into anterior, posterior, and concentric. Three calibrated examiners performed this subjective evaluation. After that, another examiner performed an objective assessment of the condyles positioning using tomographic sagittal scans of the condyles, applying the same 3D program. This objective evaluation of the condyle position, considered the gold standard (GS), was achieved by using a formula based on the measurement values of the joint spaces, anterior and posterior. The kappa test was used to assess the interexaminer agreement in determining the condyles morphology and positioning, as well as between the condyle positioning results determined by the examiners and the GS. RESULTS The results showed poor agreement among examiners and between the subjective and objective condyle positioning evaluation. CONCLUSION It was concluded that the panoramic radiography (PR), either digitalized or reconstructed from CBCT scans, is not suitable for determining variations in condyle morphology and position. CLINICAL SIGNIFICANCE Whenever it is necessary to evaluate the mandibular condyle during the orthodontic screening, the orthodontist should consider another image modality better than the PR.
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Affiliation(s)
| | | | | | - R de Lima Navarro
- Department of Dentistry, Area of Oral and Maxillofacial Surgery State University of Maringá, Maringá, Paraná, Brazil
| | - M R de Almeida
- Department of Orthodontics, University of North Parana Londrina, Paraná, Brazil
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Ladeira DBS, da Cruz AD, de Almeida SM. Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard. Braz Oral Res 2015; 29:S1806-83242015000100303. [PMID: 26892353 DOI: 10.1590/1807-3107bor-2015.vol29.0120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/19/2015] [Indexed: 11/22/2022] Open
Abstract
Three-dimensional imaging modalities have been reported to be more accurate than panoramic radiographs (PR) for the assessment of bone components of the temporomandibular joint (TMJ). No exact prior information is available that demonstrates which specific limitations occur in terms of TMJ diagnosis when using PR for this purpose. This study aimed to assess the clinical validity of digital panoramic radiography (DPR) when diagnosing morphological disorders of the TMJ using cone-beam computed tomography (CBCT) images as the gold standard. A sample composed of TMJ images (N = 848), including 212 DPR and 212 CBCT images obtained from the same patient, was used to assess any morphological changes in the TMJ. Four appraisers diagnosed all of the DPR images, whereas the CBCT images were used to establish the gold standard. The reliability of each appraiser's response pattern was analyzed using the Kappa test (κ), and diagnostic tests were performed to assess each appraiser's performance using a significance level setting of 5% (α = 0.05). Reliability of each appraiser's response pattern compared to the gold standard ranged from a slight-to-moderate agreement (0.18 ≤ κ ≤ 0.45); and among the different appraisers, the response pattern showed a fair agreement (0.22 ≤ κ ≤ 0.39). Diagnostic tests showed a wide range among the different possible morphological changes diagnosed. DPR does not have validity when diagnosing morphological changes in the TMJ; it underestimates the radiological findings with higher prevalence, and thus, it cannot be used effectively as a diagnostic tool for bone components within this region.
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Affiliation(s)
- Daniela Brait Silva Ladeira
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Adriana Dibo da Cruz
- Department of Specific Formation, Dental School of Nova Friburgo, Universidade Federal Fluminense, Nova Friburgo, RJ, Brazil
| | - Solange Maria de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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Gomes LR, Gomes M, Jung B, Paniagua B, Ruellas AC, Gonçalves JR, Styner MA, Wolford L, Cevidanes L. Diagnostic index of three-dimensional osteoarthritic changes in temporomandibular joint condylar morphology. J Med Imaging (Bellingham) 2015; 2:034501. [PMID: 26158119 PMCID: PMC4495313 DOI: 10.1117/1.jmi.2.3.034501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/09/2015] [Indexed: 11/14/2022] Open
Abstract
This study aimed to investigate imaging statistical approaches for classifying three-dimensional (3-D) osteoarthritic morphological variations among 169 temporomandibular joint (TMJ) condyles. Cone-beam computed tomography scans were acquired from 69 subjects with long-term TMJ osteoarthritis (OA), 15 subjects at initial diagnosis of OA, and 7 healthy controls. Three-dimensional surface models of the condyles were constructed and SPHARM-PDM established correspondent points on each model. Multivariate analysis of covariance and direction-projection-permutation (DiProPerm) were used for testing statistical significance of the differences between the groups determined by clinical and radiographic diagnoses. Unsupervised classification using hierarchical agglomerative clustering was then conducted. Compared with healthy controls, OA average condyle was significantly smaller in all dimensions except its anterior surface. Significant flattening of the lateral pole was noticed at initial diagnosis. We observed areas of 3.88-mm bone resorption at the superior surface and 3.10-mm bone apposition at the anterior aspect of the long-term OA average model. DiProPerm supported a significant difference between the healthy control and OA group ([Formula: see text]). Clinically meaningful unsupervised classification of TMJ condylar morphology determined a preliminary diagnostic index of 3-D osteoarthritic changes, which may be the first step towards a more targeted diagnosis of this condition.
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Affiliation(s)
- Liliane R. Gomes
- University of Michigan, School of Dentistry, Department of Orthodontics and Pediatric Dentistry, 1011 North University Avenue, Ann Arbor, Michigan 48109, United States
- UNESP Univ Estadual Paulista, Faculdade de Odontologia de Araraquara, Department of Orthodontics and Pediatric Dentistry, 1680 Humaita Street, Centro, Araraquara, São Paulo 14801-903, Brazil
| | - Marcelo Gomes
- University of Michigan, School of Dentistry, Department of Orthodontics and Pediatric Dentistry, 1011 North University Avenue, Ann Arbor, Michigan 48109, United States
- Private practice, Salvador, Bahia 41940-455, Brazil
| | - Bryan Jung
- University of North Carolina, School of Medicine, Department of Psychiatry, 101 Manning Drive, Chapel Hill, North Carolina 27599, United States
| | - Beatriz Paniagua
- University of North Carolina, School of Medicine, Department of Psychiatry, 101 Manning Drive, Chapel Hill, North Carolina 27599, United States
| | - Antonio C. Ruellas
- University of Michigan, School of Dentistry, Department of Orthodontics and Pediatric Dentistry, 1011 North University Avenue, Ann Arbor, Michigan 48109, United States
- University of North Carolina, School of Medicine, Department of Psychiatry, 101 Manning Drive, Chapel Hill, North Carolina 27599, United States
| | - João Roberto Gonçalves
- UNESP Univ Estadual Paulista, Faculdade de Odontologia de Araraquara, Department of Orthodontics and Pediatric Dentistry, 1680 Humaita Street, Centro, Araraquara, São Paulo 14801-903, Brazil
| | - Martin A. Styner
- University of North Carolina, School of Medicine, Department of Psychiatry, 101 Manning Drive, Chapel Hill, North Carolina 27599, United States
| | - Larry Wolford
- Federal University of Rio de Janeiro, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Carlos Chagas Filho Avenue, Cidade Universitária, Rio de Janeiro 21941-902, Brazil
| | - Lucia Cevidanes
- University of Michigan, School of Dentistry, Department of Orthodontics and Pediatric Dentistry, 1011 North University Avenue, Ann Arbor, Michigan 48109, United States
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Assessment of condylar changes in patients with temporomandibular joint pain using digital volumetric tomography. Radiol Res Pract 2014; 2014:106059. [PMID: 25332835 PMCID: PMC4190052 DOI: 10.1155/2014/106059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/19/2014] [Accepted: 09/07/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To evaluate the efficiency of DVT in comparison with OPG in the assessment of bony condylar changes in patients of TMJ pain. Methods. 100 temporomandibular joints of 62 patients with the complaint of temporomandibular joint pain were included in the study. DVT and OPG radiographs were taken for all the 100 joints. Three observers interpreted the DVT and OPG radiograph for the bony changes separately for two times with an interval of one week. The bony changes seen in the condyle were given coding from 0 to 6. (0: Normal, 1: Erosion, 2: Flattening, 3: Osteophyte, 4: Sclerosis, 5: Resorption, and 6: other changes). Interobserver and intraobserver variability was assessed with one-way ANOVA statistics. Z test was used to see the significant difference between OPG and DVT. Results. In the present study the interexaminer reliability for OPG and DVT was 0.903 and 0.978, respectively. Intraexaminer reliability for OPG and DVT was 0.908 and 0.980, respectively. The most common condylar bony change seen in OPG and DVT was erosion followed by flattening and osteophyte. There was significant difference between OPG and DVT in detecting erosion and osteophytes. The other changes observed in our study were Ely's cyst, pointed condyle, and bifid condyle. All the bony changes are more commonly seen in females than males. Conclusion. DVT provides more valid and accurate information on condylar bony changes. The DVT has an added advantage of lesser radiation exposure to the patient and cost effectiveness and could be easily accessible in a dental hospital.
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Patel A, Tee BC, Fields H, Jones E, Chaudhry J, Sun Z. Evaluation of cone-beam computed tomography in the diagnosis of simulated small osseous defects in the mandibular condyle. Am J Orthod Dentofacial Orthop 2014; 145:143-56. [DOI: 10.1016/j.ajodo.2013.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 12/20/2022]
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Dias GJ, Premachandra IM, Mahoney PM, Kieser JA. A New Approach to Improve TMJ Morphological Information from Plain Film Radiographs. Cranio 2014; 23:30-8. [PMID: 15727319 DOI: 10.1179/crn.2005.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The hard tissues of the temporomandibular joint (TMJ) can be assessed through radiographic imaging to provide information to assist in diagnosis and treatment. However, the quality of information gathered from such imaging is often less than desired due to the small size of the TMJ, the widely varying fossa and condylar morphology, and the surrounding dense osseous structures. These make a clear and undistorted radiographic image of the hard tissue of the joint technically difficult. It is postulated that, if the degree of inaccuracy of a given radiograph is known quantitatively and taken into account, the clinician will be able to make a better informed qualitative assessment of TMJ morphology. The aim of this study is: 1. to improve the qualitative information that can be acquired from routine clinical plain film radiographs of the TMJ; 2. to use quantitative data to test the novel Neural Network (NN) model; and 3. to statistically show the discrepancies between routine radiographic images and the actual joint. Linear measurements of excised TMJs and their radiographic images were used to train a multilayer perceptron (MP) type NN model to predict joint dimensions more accurately. Such a neural network, developed using a statistical software package such as SPSS (SPSS, Inc. Chicago, IL), functions as a computer software program and predicts joint dimensions with increased accuracy when radiographic measurements are entered into the program. The NN model described here predicts the actual linear distances of the TMJ more closely than radiographic measurements and is more reliable in assessing the TMJ morphology.
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Affiliation(s)
- George J Dias
- Dept. of Anatomy and Structural Biology, Dunedin, New Zealand.
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15
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Lee JY, Kim DJ, Lee SG, Chung JW. A longitudinal study on the osteoarthritic change of the temporomandibular joint based on 1-year follow-up computed tomography. J Craniomaxillofac Surg 2012; 40:e223-8. [DOI: 10.1016/j.jcms.2011.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 10/09/2011] [Accepted: 10/11/2011] [Indexed: 11/25/2022] Open
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Palconet G, Ludlow JB, Tyndall DA, Lim PF. Correlating cone beam CT results with temporomandibular joint pain of osteoarthritic origin. Dentomaxillofac Radiol 2011; 41:126-30. [PMID: 22116122 DOI: 10.1259/dmfr/60489374] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine whether bony changes in temporomandibular joint (TMJ) osteoarthritis (OA) is correlated with pain and other clinical signs and symptoms. METHODS Clinical data and cone beam CT (CBCT) images of 30 patients with TMJ OA were analysed. The criteria of Koyama et al (Koyama J, Nishiyama H, Hayashi T. Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder. Dentomaxillofac Radiol 2007; 36: 472-477.) and Ahmad et al [Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844-860.] were used to classify the condyles observed on the CBCT. Clinical measures included self-reported pain, mandibular range of motion, TMJ sound, pain on palpation of the TMJ and masticatory muscles, and pain on jaw function. Generalized linear modelling was used to correlate the clinical and radiographic findings and Spearman's rho was used to correlate the two classification systems. RESULTS There was poor correlation between the maximum condyle change and pain rating (Koyama: r² = 0.1443, p = 0.3995; Ahmad: r² = 0.0273, p = 0.9490), maximum mouth opening (Koyama: r² = 0.2910, p = 0.0629; Ahmad: r² = 0.2626, p = 0.0951), protrusion (Koyama: r² = 0.0875, p = 0.7001; Ahmad: r² = 0.1658, p = 0.3612), right lateral motion (Koyama: r² = 0.0394, p = 0.9093; Ahmad: r² = 0.0866, p = 0.6877) and left lateral motion (Koyama: r² = 0.0943, p = 0.6494; Ahmad: r² = 0.1704, p = 0.3236). Strong correlation was observed between Koyama et al's and Ahmad et al's classifications for average (r = 0.9216, p < 0.001) and maximum (r = 0.7694; p < 0.0001) bony change. CONCLUSIONS There was poor correlation between condylar changes (as observed on CBCT images), pain and other clinical signs and symptoms in TMJ OA.
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Affiliation(s)
- G Palconet
- University of North Carolina, Chapel Hill School of Dentistry, NC 27599-7455, USA
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Marques AP, Perrella A, Arita ES, Pereira MFSDM, Cavalcanti MDGP. Assessment of simulated mandibular condyle bone lesions by cone beam computed tomography. Braz Oral Res 2011; 24:467-74. [PMID: 21180970 DOI: 10.1590/s1806-83242010000400016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 09/10/2010] [Indexed: 12/15/2022] Open
Abstract
There are many limitations to image acquisition, using conventional radiography, of the temporomandibular joint (TMJ) region. The Computed Tomography (CT) scan is a better option, due to its higher accuracy, for purposes of diagnosis, surgical planning and treatment of bone injuries. The aim of the present study was to analyze two protocols of cone beam computed tomography for the evaluation of simulated mandibular condyle bone lesions. Spherical lesions were simulated in 30 dry mandibular condyles, using dentist drills and drill bits sizes 1, 3 and 6. Each of the mandibular condyles was submitted to cone beam computed tomography (CBCT) using two protocols: 1) axial, coronal and sagittal multiplanar reconstruction (MPR); and 2) sagittal plus coronal slices throughout the longitudinal axis of the mandibular condyles. For these protocols, 2 observers analyzed the CBCT images independently, regarding the presence or not of injuries. Only one of the observers, however, performed on 2 different occasions. The results were compared to the gold standard, evaluating the percentage of agreement, degree of accuracy of CBCT protocols and observers' examination. The z test was used for the statistical analysis. The results showed there were no statistically significant differences between the 2 protocols. There was greater difficulty in the assessment of small-size simulated lesions (drill # 1). From the results of this study, it can be concluded that CBCT is an accurate tool for analyzing mandibular condyle bone lesions, with the MPR protocol showing slightly better results than the sagittal plus coronal slices throughout the longitudinal axis.
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Look JO, Schiffman EL, Truelove EL, Ahmad M. Reliability and validity of Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) with proposed revisions. J Oral Rehabil 2010; 37:744-59. [PMID: 20663019 DOI: 10.1111/j.1365-2842.2010.02121.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The research diagnostic criteria for temporomandibular disorders (RDC/TMD) have been employed internationally since 1992 for the study of temporomandibular muscle and joint disorders (TMD). This diagnostic protocol incorporates a dual system for assessment of TMD for Axis I physical diagnoses as well as Axis II psychological status and pain-related disability. Because the reliability and criterion validity of RDC/TMD had not yet been comprehensively characterised, the National Institute of Dental and Craniofacial Research funded in 2001 the most definitive research to date on the RDC/TMD as a U01 project entitled, 'Research Diagnostic Criteria: Reliability and Validity'. The results of this multi-site collaboration involving the University of Minnesota, the University of Washington, and the University at Buffalo were first reported at a pre-session workshop of the Toronto general session of the International Association of Dental Research on 2 July 2008. Summaries of five reports from this meeting are presented in this paper including: (i) reliability of RDC/TMD Axis I diagnoses based on clinical signs and symptoms; (ii) reliability of radiographic interpretations used for RDC/TMD Axis I diagnoses; (iii) reliability of self-report data used for RDC/TMD Axis I diagnoses; (iv) validity of RDC/TMD Axis I diagnoses based on clinical signs and symptoms; and (v) proposed revisions of the RDC/TMD Axis I diagnostic algorithms.
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Affiliation(s)
- J O Look
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
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Utumi ER, Perrella A, Albuquerque MAP, Adde CA, Rocha RG, Cavalcanti MGP. Evaluation of simulated bone lesion in the head of the mandible by using multislice computed tomography. J Appl Oral Sci 2010; 17:521-6. [PMID: 19936536 PMCID: PMC4327684 DOI: 10.1590/s1678-77572009000500030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 11/30/2008] [Indexed: 11/22/2022] Open
Abstract
Conventional radiography has shown limitation in acquiring image of the ATM region, thus, computed tomography (CT) scanning has been the best option to the present date for diagnosis, surgical planning and treatment of bone lesions, owing to its specific properties. Objective: The aim of the study was to evaluate images of simulated bone lesions at the head of the mandible by multislice CT. Material and methods: Spherical lesions were made with dental spherical drills (sizes 1, 3, and 6) and were evaluated by using multislice CT (64 rows), by two observers in two different occasions, deploying two protocols: axial, coronal, and sagittal images, and parasagittal images for pole visualization (anterior, lateral, posterior, medial and superior). Acquired images were then compared with those lesions in the dry mandible (gold standard) to evaluate the specificity and sensibility of both protocols. Statistical methods included: Kappa statistics, validity test and chi-square test. Results demonstrated the advantage of associating axial, coronal, and sagittal slices with parasagittal slices for lesion detection at the head of the mandible. Results: There was no statistically significant difference between the types of protocols regarding a particular localization of lesions at the poles. Conclusions: Protocols for the assessment of the head of the mandible were established to improve the visualization of alterations of each of the poles of the mandible's head. The anterior and posterior poles were better visualized in lateral-medial planes while lateral, medial and superior poles were better visualized in the anterior-posterior plane.
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Affiliation(s)
- Estevam Rubens Utumi
- Department of Stomatology, Dental School, University of São Paulo, São Paulo, Brazil
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Winocur E, Reiter S, Krichmer M, Kaffe I. Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis. J Oral Rehabil 2009; 37:171-7. [PMID: 20002532 DOI: 10.1111/j.1365-2842.2009.02035.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94.4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20.0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11.1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.
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Affiliation(s)
- E Winocur
- Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, John MT, Schiffman EL. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. ACTA ACUST UNITED AC 2009; 107:844-60. [PMID: 19464658 DOI: 10.1016/j.tripleo.2009.02.023] [Citation(s) in RCA: 409] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 12/17/2008] [Accepted: 02/09/2009] [Indexed: 01/05/2023]
Abstract
OBJECTIVE As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT). STUDY DESIGN Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA). RESULTS For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA. CONCLUSION Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.
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Affiliation(s)
- Mansur Ahmad
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota 55455, USA.
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22
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Magnetic resonance imaging in the diagnosis of intra-articular adhesions of the temporomandibular joint. Br J Oral Maxillofac Surg 2009; 47:389-92. [DOI: 10.1016/j.bjoms.2008.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2008] [Indexed: 11/21/2022]
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23
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Hintze H, Wiese M, Wenzel A. Comparison of three radiographic methods for detection of morphological temporomandibular joint changes: panoramic, scanographic and tomographic examination. Dentomaxillofac Radiol 2009; 38:134-40. [DOI: 10.1259/dmfr/31066378] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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24
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Osseous changes and condyle position in TMJ tomograms: impact of RDC/TMD clinical diagnoses on agreement between expected and actual findings. ACTA ACUST UNITED AC 2008; 106:e52-63. [DOI: 10.1016/j.tripleo.2008.03.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 01/30/2008] [Accepted: 03/15/2008] [Indexed: 11/17/2022]
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Hussain AM, Packota G, Major PW, Flores-Mir C. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review. Dentomaxillofac Radiol 2008; 37:63-71. [PMID: 18239033 DOI: 10.1259/dmfr/16932758] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To evaluate the ability of different diagnostic imaging techniques for diagnosing the presence of erosions and osteophytes in the temporomandibular joint (TMJ). METHODS A systematic search of PubMed, Medline, all Evidence Based Medicine (EBM) reviews, Embase, Web of Sciences and Lilacs identified nine articles that met the selection criteria: some type of TMJ diagnostic imaging, data from autopsy or dry skull TMJs as gold standard, absence of diagnosed systemic arthritis and evaluation of the presence of erosions and/or osteophytes. A hand search of the references of the selected articles was also performed. RESULTS Selected studies evaluated panoramic imaging (unenhanced and colour-enhanced digital subtraction panoramic imaging), axially corrected sagittal tomography, axially corrected frontal tomography, sagittal MRI, CT, high-resolution ultrasound and cone beam CT (CBCT). CONCLUSIONS Axially corrected sagittal tomography is currently the imaging modality of choice for diagnosing erosions and osteophytes in the TMJ. CT does not seem to add any significant information to what is obtained from axially corrected sagittal tomography. CBCT might prove to be a cost- and radiation dose-effective alternative to axially corrected sagittal tomography. Combining different radiographic techniques is likely to be more accurate in diagnosing erosions and osteophytes in the TMJ than using a single imaging modality. Diagnostic studies that simultaneously evaluate all of the available TMJ imaging technologies are needed.
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Affiliation(s)
- A M Hussain
- Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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26
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Hintze H, Wiese M, Wenzel A. Cone beam CT and conventional tomography for the detection of morphological temporomandibular joint changes. Dentomaxillofac Radiol 2007; 36:192-7. [PMID: 17536085 DOI: 10.1259/dmfr/25523853] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of cone beam CT images with conventional tomographic images for the detection of morphological temporomandibular joint (TMJ) changes. METHODS 80 dry human skulls were scanned using a NewTom 3G scanner and lateral and frontal reconstructions of the right and the left TMJs were performed. In addition, lateral and frontal cross-sectional tomograms of the skulls' TMJs were obtained in a Cranex Tome unit with Digora storage phosphor plates. Naked-eye inspection of the TMJs performed by three observers served as the gold standard for the true presence of morphological changes. The mandibular fossae were excluded from the study due to few changes in this joint component. The NewTom and the conventional tomographic images were examined by three independent observers using a binary scale for the presence of morphological changes in the condyle (flattening, defects and osteophytes) and the articular tubercle (flattening and defects). The accuracy for the different types of changes in relation to the condyles and the articular tubercles was expressed as sensitivity and specificity values, whereas the diagnostic accuracy for a general assessment including all changes in both joint components was expressed by the sum of cases where the gold standard and the radiographic scores were not identical (absolute difference). Differences between the two radiographic modalities were tested by paired t-test. RESULTS Detection of the various types of morphological changes in relation to the condyle and the articular tubercle assessed separately resulted in no significant differences between the two radiographic modalities, with the exception of bone defects in the articular tubercle examined on frontal views alone where the specificity with tomography was significantly higher than with cone beam CT. Detection of all morphological changes in relation to both the condyle and the articular tubercle showed a significantly higher accuracy with tomography than with cone beam CT using lateral views alone, but there was no significant difference between the two modalities using frontal views alone and lateral and frontal views in combination. CONCLUSION In general, no significant differences in diagnostic accuracy for the detection of bone changes in the condyle and in the articular tubercle were found between cone beam CT images and conventional tomograms.
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Affiliation(s)
- H Hintze
- Department of Oral Radiology, School of Dentistry, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus C, Denmark.
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Zhang S, Yang C, Zheng J, Wang X, Fan X. Plain Film Arthrography Applied to the Diagnosis of Intra-Articular Adhesions of the Temporomandibular Joint. J Oral Maxillofac Surg 2007; 65:212-7. [PMID: 17236923 DOI: 10.1016/j.joms.2005.10.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 10/04/2005] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of plain film arthrography (PFA) on the presence of intra-articular adhesions of the temporomandibular joint (TMJ). PATIENTS AND METHODS The study population included 105 consecutive patients (105 TMJs) and data collected in our department. All patients were examined by PFA and arthroscopy. The findings of interpreting PFA were recorded as positive, suspicious, or negative according to the PFA radiographic criteria. After comparing the findings of PFA with those of arthroscopy, the comparison data were assessed by generating receiver operating characteristic curve (ROC curve) and analyzing the area (A(z)) under the curves with SPSS 11.0 (SPSS, Inc, Chicago, IL), and the area under the ROC curve was calculated. According to the area, the diagnostic value of PFA was evaluated. Meanwhile, the causes of misdiagnosis and underdiagnosis of intra-articular adhesions were analyzed. RESULTS Arthroscopic surgery results confirmed that 56 TMJs in 105 patients had adhesions. The area under ROC curve was 0.73 (confidence interval, 0.64, 0.82; P < .05). The adhesions located in the medial groove could hardly be detected through PFA, while those located in the lateral two thirds of upper joint compartment could easily be detected. CONCLUSION Although the diagnostic accuracy of PFA was fair, it was a simple and effective modality to diagnose intra-articular adhesions of the TMJ. The causes of misdiagnosis and underdiagnosis were related to the size and location of the intra-articular adhesions.
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Affiliation(s)
- ShanYong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Second Medical University, People's Republic of China
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28
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Wiese M, Hintze H, Svensson P, Wenzel A. Comparison of diagnostic accuracy of film and digital tomograms for assessment of morphological changes in the TMJ. Dentomaxillofac Radiol 2007; 36:12-7. [PMID: 17329582 DOI: 10.1259/dmfr/78486936] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare diagnostic accuracy of tomograms obtained with film and three digital image receptor modalities for detection of morphological changes in the temporomandibular joint (TMJ). METHODS Lateral and frontal cross-sectional tomograms of 158 TMJs in 80 dry human skulls were obtained with four X-ray receptors: one conventional film (Agfa-Gevaert), two photostimulable phosphor (PSP) plates: VistaScan and Digora PCT and one charge-coupled device (CCD): ProMax. The film and the PSP plate tomograms were exposed in a Cranex Tome X-ray unit and the CCD tomograms in the ProMax X-ray unit. The tomograms were examined by three observers for the presence of morphological changes in the condyle, the mandibular fossa and the articular tubercle. Naked-eye inspection of the articular surfaces of the TMJs performed by the same three observers served as the gold standard for the true presence of morphological changes. RESULTS For examination of TMJ changes using lateral and frontal tomograms in combination and lateral tomograms separately, the ProMax modality obtained a significant lower diagnostic accuracy than the other three modalities, between which no significant differences were found. For morphological changes localized to the condyle in which the highest number of changes were present according to the gold standard, the same result was found. CONCLUSION The ProMax modality was significantly less accurate than the film, VistaScan and Digora PCT modalities for the detection of overall TMJ morphological bone changes as well as condylar bone changes.
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Affiliation(s)
- M Wiese
- Department of Oral Radiology, University of Aarhus, Aarhus, Denmark.
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Yang C, Zhang SY, Wang XD, Fan XD. Magnetic resonance arthrography applied to the diagnosis of intraarticular adhesions of the temporomandibular joint. Int J Oral Maxillofac Surg 2005; 34:733-8. [PMID: 15979852 DOI: 10.1016/j.ijom.2005.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 11/11/2004] [Accepted: 02/04/2005] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to investigate the diagnostic accuracy of magnetic resonance arthrography (MRAr) on the diagnosis of intraarticular adhesions of the temporomandibular joint (TMJ). Twenty-four patients (31 joints) diagnosed as internal disorders of TMJ were examined to establish the presence, suspicion or absence of intraarticular adhesions through MRAr according to the MRAr radiographic criteria in a blind fashion, subsequent arthroscopy were performed on all 31 joints. The findings were compared to MRAr with those of arthroscopy. The comparison data were assessed by generating receiver operating characteristic curve (ROC curve) and analyzing the area (Az) under the curve with SPSS11.0 software. The area under the ROC curve was 0.91 (0.86, 0.95), P<0.05. MRAr proves to be an excellent modality to diagnose intraarticular adhesions of TMJ.
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Affiliation(s)
- C Yang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Second Medical University, 200011 Shanghai, PR China.
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Crow HC, Parks E, Campbell JH, Stucki DS, Daggy J. The utility of panoramic radiography in temporomandibular joint assessment. Dentomaxillofac Radiol 2005; 34:91-5. [PMID: 15829691 DOI: 10.1259/dmfr/24863557] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Panoramic radiography was used to determine (1) intrarater and inter-rater reliability in assessing temporomandibular joint (TMJ) condylar morphology; (2) alteration in condylar shape in patients with temporomandibular disorders (TMD) and controls when matched by age, gender, and state of dentition; and (3) prevalence of condylar abnormalities in individuals with and without TMD. METHODS One hundred panoramic radiographs were randomly selected from a hospital clinic (45 TMD and 55 non-TMD patients). The images were cropped to include only the temporomandibular apparatus and were independently evaluated by three examiners without knowledge of the patient's clinical status. Multiple statistical tests were performed to evaluate the accumulated data. RESULTS Intrarater reliability demonstrated substantial agreement, while inter-rater reliability was fair. There was no difference in condylar morphology between patient groups, but mild condylar change was prevalent in all age groups, regardless of TMD status. CONCLUSIONS Morphological condylar abnormalities are present on panoramic images in all adult age ranges, regardless of status of the dentition or presence of TMD. Condylar shape alone is not an indicator of TMD, and minor condylar discrepancies may have no significance in TMD.
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Affiliation(s)
- H C Crow
- Department of Oral Diagnostic Sciences, TMD and Orofacial Pain Program, University at Buffalo, Buffalo, NY 14214, USA.
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Mawani F, Lam EWN, Heo G, McKee I, Raboud DW, Major PW. Condylar shape analysis using panoramic radiography units and conventional tomography. ACTA ACUST UNITED AC 2005; 99:341-8. [PMID: 15716843 DOI: 10.1016/j.tripleo.2004.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare condyle shape between lateral temporomandibular joint (TMJ) images from axially corrected tomography and 3 panoramic radiography units with TMJ-specific programs. STUDY DESIGN The TMJ from a single dry human skull was imaged with multidirectional tomography and the following 3 panoramic radiography units: Instrumentarium OP 100, Planmeca PM 2002 CC Proline, and Soredex Orthophos DS. A curve-fitting procedure (spline curves) was used to mathematically describe condyle outlines. One sample t tests were used to compare panoramic images against the tomograms (gold standard). RESULTS A significant difference (P < .05) in condyle shape was found between TMJ tomography images and each of the 3 panoramic images. Images from the PM 2002 CC Proline demonstrated the smallest shape difference (13.4%), followed by the OP 100 (17.5%) and the Orthophos DS (24.8%). CONCLUSION If panoramic radiography is to be used for the initial radiographic examination of the TMJ, practitioners should be aware of the potential for shape distortion of the condyle.
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Affiliation(s)
- Farah Mawani
- Private Practice, Vancouver, British Columbia, Canada
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Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG, Omnell KA, Westesson PL, White SC. Imaging of the temporomandibular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 83:609-18. [PMID: 9159823 DOI: 10.1016/s1079-2104(97)90128-1] [Citation(s) in RCA: 186] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Various imaging techniques for the temporomandibular joint are discussed with respect to uses, strengths, and limitations. An imaging protocol is outlined for evaluating patients with a wide variety of temporomandibular joint related signs and symptoms.
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