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Meral SE, Koç O, Tosun E, Tüz HH. Effects of sagittal split Ramus osteotomy on condylar position and Ramal orientation in patients with mandibular asymmetry. Clin Oral Investig 2023; 28:65. [PMID: 38158456 DOI: 10.1007/s00784-023-05400-9] [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: 09/22/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry. METHODS A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the "Wilcoxon signed-ranks test" to identify differences between groups. RESULTS Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups (p = 0.018 and p = 0.010, respectively). CONCLUSIONS SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment. CLINICAL RELEVANCE Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered.
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Affiliation(s)
- Salih Eren Meral
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey.
| | - Onur Koç
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Emre Tosun
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Hakan H Tüz
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
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Augdal TA, Angenete OW, Shi XQ, Säll M, Fischer JM, Nordal E, Rosendahl K. Cone beam computed tomography in the assessment of TMJ deformity in children with JIA: repeatability of a novel scoring system. BMC Oral Health 2023; 23:12. [PMID: 36627622 PMCID: PMC9830735 DOI: 10.1186/s12903-022-02701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The temporomandibular joint (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA). Diagnostic imaging is necessary to correctly diagnose and evaluate TMJ involvement, however, hitherto little has been published on the accuracy of the applied scoring systems and measurements. The present study aims to investigate the precision of 20 imaging features and five measurements based on cone beam computed tomography (CBCT). METHODS Imaging and clinical data from 84 participants in the Norwegian study on juvenile idiopathic arthritis, the NorJIA study, were collected. Altogether 20 imaging features and five measurements were evaluated independently by three experienced radiologists for intra- and interobserver agreement. Agreement of categorical variables was assessed by Fleiss', Cohen's simple or weighted Kappa as appropriate. Agreement of continuous variables was assessed with 95% limits of agreement as advised by Bland and Altman. RESULTS "Overall impression of TMJ deformity" showed almost perfect intraobserver agreement with a kappa coefficient of 0.81 (95% CI 0.69-0.92), and substantial interobserver agreement (Fleiss' kappa 0.70 (0.61-0.78)). Moreover, both "flattening" and "irregularities" of the eminence/fossa and condyle performed well, with intra- and interobserver agreements of 0.66-0.82 and 0.55-0.76, respectively. "Reduced condylar volume" and "continuity" of the fossa/eminence had moderate intra- and interobserver Kappa values, whereas continuity of the condyle had Kappa values above 0.55. Measurements of distances and angles had limits of agreement of more than 15% of the sample mean. CONCLUSIONS We propose a CBCT-based scoring system of nine precise imaging features suggestive of TMJ deformity in JIA. Their clinical validity must be tested.
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Affiliation(s)
- Thomas A. Augdal
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskar W. Angenete
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Institute for Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xie-Qi Shi
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.32995.340000 0000 9961 9487Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Mats Säll
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Johannes M. Fischer
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ellen Nordal
- grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Karen Rosendahl
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Fischer J, Augdal TA, Angenete O, Gil EG, Skeie MS, Åstrøm AN, Tylleskär K, Rosendahl K, Shi XQ, Rosén A. In children and adolescents with temporomandibular disorder assembled with juvenile idiopathic arthritis - no association were found between pain and TMJ deformities using CBCT. BMC Oral Health 2021; 21:518. [PMID: 34641860 PMCID: PMC8513178 DOI: 10.1186/s12903-021-01870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA. Methods This cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015–2020, including 228 children and adolescents aged 4–16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT. Results Of 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031). Conclusions There was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01870-z.
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Affiliation(s)
- J Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
| | - T A Augdal
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - O Angenete
- Department of Radiology and Nuclear Medicine, St. Olav Hospital HF, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - E G Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - M S Skeie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - A N Åstrøm
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Public Dental Service Competence Centre of Western-Norway (TkVest), Bergen, Norway
| | - K Tylleskär
- Paediatric Clinic at Haukeland University Hospital, Bergen, Norway
| | - K Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway.,UiT Arctic University of North Norway, Tromsø, Norway
| | - X-Q Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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Cavagnetto D, Abate A, Caprioglio A, Cressoni P, Maspero C. Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study. Prog Orthod 2021; 22:32. [PMID: 34595615 PMCID: PMC8484372 DOI: 10.1186/s40510-021-00380-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is currently no information on how different mandibular segments are affected by juvenile idiopathic arthritis. The aim of this paper is to assess volumetric differences of different mandibular segments in subjects with unilateral and bilateral JIA and to compare them with non-JIA control volumes. MATERIALS AND METHODS Forty subjects with unilateral TMJ involvement and 48 with bilateral TMJ involvement were selected for the case group and 45 subjects with no known rheumatic comorbidities for the control group. The mandible of each subject was divided according to a validated method into different paired volumes (hemimandible, condyle, ramus and hemibody). RESULTS The ANOVA test revealed a statistically significant difference in all the groups for condylar and ramus volumes, and the pairwise comparison evidenced a statistically significant higher condylar and ramus volume in the control group (1444.47 mm3; 5715.44 mm3) than in the affected side in the unilateral JIA group (929.46 mm3; 4776.31 mm3) and the bilateral JIA group (1068.54 mm3; 5715.44 mm3). Moreover, there was also a higher condylar volume in the unaffected side in the unilateral JIA group (1419.39 mm3; 5566.24 mm3) than in the bilateral JIA group and the affected side in the unilateral JIA group. CONCLUSIONS The affected side of unilateral JIA patients showed statistically significant lower volumes in the hemimandible, in the condyle and in the ramus. The largest total mandibular volume was observed in the control group, followed by the unilateral JIA group and, lastly, by the bilateral JIA group.
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Affiliation(s)
- Davide Cavagnetto
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy. .,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
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Arif CA, Randy C, Matthew S, Serhat S, Brian K, Peter W, Jue W, Viet V, Linh T, How KC. Comparison of the condyle-fossa relationship and resorption between patients with and without Juvenile Idiopathic Arthritis (JIA). J Oral Maxillofac Surg 2021; 80:422-430. [PMID: 34627744 DOI: 10.1016/j.joms.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The most common disease in pediatric rheumatology is juvenile idiopathic arthritis (JIA). JIA is considered to be an autoimmune disease with an onset before the age of 16. The temporal mandibular joint (TMJ) has been reported to be involved in up to 87% of patients with JIA. Even though substantial research has been conducted on JIA, limited research has studied to understand its effect on the condyle-fossa relationship and to evaluate resorption amount on condyle by using a scoring system. AIM The purpose of this study was 1) to compare condyle - fossa relationships in the temporomandibular joint (TMJ), 2) was to score condylar resorption by using a TMJ indexing system in patients with JIA and without JIA. METHODS The present retrospective cross-sectional study included cone-beam computed tomography (CBCT) images obtained from the sagittal, coronal, and axial slices. In the multidisciplinary Pediatric Rheumatology Outpatient Clinic at The University of Alabama at Birmingham (UAB) children with JIA are also examined by a group of orthodontists working in the same institute from October 2018 to July 2019. The predictor variable consists of patients with JIA and without JIA. The primary outcome variables are the depth of the mandibular fossa, joint spaces, axial angles, medio-lateral width, and condyle resorption. Other study variables were age and sex. In this study, the measurements obtained from 2 different groups (with JIA and without JIA) are compared using a t-test, where Tukey is utilized to adjust for multiple comparisons. The left and right joints are analyzed separately as the paired t test conducted showed a significant difference between the 2 joints (P < .05). RESULTS The study was comprised of 34 patients diagnosed with JIA and 34 healthy subjects. The depth of the mandibular fossa, the anterior joint spaces, the axial angles, and the resorption index showed statistically significant differences between the JIA and healthy groups in both left and right sides (P < .05). However, there was no statistically significant difference in the posterior joint spaces and mediolateral width between JIA and healthy groups in both sides (P > .05). CONCLUSIONS The results of our study presented the destructive potential of juvenile idiopathic arthritis by using CBCT. CBCT scanning is a helpful tool in the evaluation of the radiographic result of TMJ.
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Affiliation(s)
- Celebi Ahmet Arif
- Department of Orthodontics, School of Dentistry, University of Alabama Birmingham, Birmingham
| | - Cron Randy
- Department of Pediatric Rheumatology, University of Alabama Birmingham, Birmingham
| | - Stoll Matthew
- Department of Pediatric Rheumatology, University of Alabama Birmingham, Birmingham
| | - Simsek Serhat
- Feliciano School of Business, Montclair State University, New Jersey
| | - Kinard Brian
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama, Birmingham
| | - Waite Peter
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama, Birmingham
| | - Wang Jue
- Department of Orthodontics, School of Dentistry, University of Alabama Birmingham, Birmingham
| | - Vo Viet
- School of Dentistry, University of Alabama, Birmingham
| | - Tran Linh
- School of Dentistry, University of Alabama, Birmingham
| | - Kau Chung How
- Department of Orthodontics, School of Dentistry, University of Alabama Birmingham, Birmingham.
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Morgan N, Suryani I, Shujaat S, Jacobs R. Three-dimensional facial hard tissue symmetry in a healthy Caucasian population group: a systematic review. Clin Oral Investig 2021; 25:6081-6092. [PMID: 34386858 DOI: 10.1007/s00784-021-04126-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the symmetry of the facial hard tissue structures using three-dimensional radiographic imaging modalities in a normal Caucasian population group. MATERIALS AND METHODS Electronic literature search was conducted in the following databases: PubMed, Embase, Web of Science, and Cochrane Library up to February 2021. The studies assessing symmetry of facial bones using computed tomography (CT) and cone beam CT were included. RESULTS The initial search revealed 8811 studies. Full-text analysis was performed on 33 studies. Only 10 studies were found eligible based on the inclusion criteria. The qualitative analysis revealed that a significant variability existed in relation to the methodologies applied for symmetry quantification. CONCLUSION The current review suggested that the overall relative symmetry of the normal Caucasian population group varied depending on the skeletal structure being assessed; however, majority of the observations showed a symmetry within the range of 1 mm without any significant difference between left and right sides. CLINICAL RELEVANCE The quantification of facial hard tissue structure symmetry is vital for the diagnosis and treatment planning of orthodontic and/or maxillofacial surgical procedures. Prospero registration number CRD42020169908.
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Affiliation(s)
- Nermin Morgan
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium.
- Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
| | - Isti Suryani
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint Rafaël, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Evaluation of various low-dose cone-beam computed tomography protocols in the diagnosis of specific condylar defects. Am J Orthod Dentofacial Orthop 2021; 159:491-501.e2. [PMID: 33541784 DOI: 10.1016/j.ajodo.2020.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This study aimed to determine the identifiability and measurement accuracy of defined bony defects of the temporomandibular joint (TMJ) in cone-beam computed tomographies, depending on different milliampere-second (mAs)-reduced protocols. METHODS Defined artificial defects were prepared on 30 condyles from 15 intact pig heads, with a maximum of surrounding soft tissue preserved. Three-dimensional imaging was performed using ProMax 3D Mid (Planmeca, Helsinki, Finland). The scan protocol with maximum resolution and without mAs-reduction was defined as control. Twenty-six mAs-reduced imaging protocols were analyzed by 1 examiner regarding the protocol-specific measurement accuracy. Defect depth (DD) was divided into 3 categories: I, <2 mm; II, 2-3 mm; and III, >3 mm. The protocol-specific sensitivity and specificity were evaluated in relation to localization and defect size as determined from the results of 3 examiners. RESULTS There was a significant difference from the control protocol in DD measurement in 8 mAs-reduced protocols, P <0.001-0.027. In most protocols, there was no significant difference in measurement accuracy concerning defect size and localization. The mean sensitivity reached values between 93.3% and 98.6% and differed significantly among protocols (P = 0.002). The mean specificity amounted to 97.0%-98.1% and did not differ among protocols (P = 0.462). The specificity of DD III (99.1%) was higher than DD I (97.7%) and DD II (97.1%). There was a significant difference in specificity and sensitivity concerning defect localization (P <0.001). CONCLUSIONS This study showed that mAs-reduced cone-beam computed tomographies protocols are suitable for the analysis of defined osseous TMJ defects. When 3-dimensional TMJ imaging is indicated because of potential erosive defects, validated mAs-reduced scan protocols should be applied instead of high-definition protocols.
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Bone Changes in the Condylar Process of the Mandible in Computed Tomography Images and Cephalogram in a Female Patient during a Growth Spurt Treated with a Removable Functional Appliance. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8887182. [PMID: 33133474 PMCID: PMC7568775 DOI: 10.1155/2020/8887182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022]
Abstract
Introduction Functional treatment is the type of treatment preferred in young patients with lateral bite because it leads to simultaneous improvement of occlusion and facial profile. Objective The aim of this study is to assess bone changes within the condylar process of the mandible and to associate them with the changes observed in the analysis of lateral cephalograms and in the patient's occlusion. Materials and Methods Cone beam tomography of the temporomandibular joint, lateral radiogram of the skull, was performed at the beginning of treatment and after one year of therapy. Changes in cephalometric radiograms were evaluated by analyzing them and shown by making superimposition and staining layers. For the purpose of assessing bone changes within the condylar process, digital 3D solids of these processes were generated using data from computed tomography. Results Correction towards Angle's dental class I, overjet reduction from 8 mm to 3 mm, and improvement of the patient's profile were obtained. A rotation of the occlusal plane and improvement in an ANB by 1° and in the WITS measurement by 2.7 mm were observed. A growth of the condylar processes "backwards" and "upwards" was also observed, as well as a change of their shape and volume. Conclusions The obtained results suggest that the patient's significant improvement in occlusal conditions is due to posterior growth stimulation of the condylar processes of the mandible. The results confirm the validity of using this treatment technique in the case of growing children with complete posterior occlusion.
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De Grauwe A, Ayaz I, Shujaat S, Dimitrov S, Gbadegbegnon L, Vande Vannet B, Jacobs R. CBCT in orthodontics: a systematic review on justification of CBCT in a paediatric population prior to orthodontic treatment. Eur J Orthod 2020; 41:381-389. [PMID: 30351398 PMCID: PMC6686083 DOI: 10.1093/ejo/cjy066] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Taking into account radiation doses, safety, and protection, we highlighted the features in which cone-beam computed tomography (CBCT) can offer an advantage compared to the conventional two-dimensional imaging in paediatric dentistry before orthodontic treatment. OBJECTIVE The aim of this article was to conduct a systematic review to assess the diagnostic efficacy of CBCT in the paediatric population at a pre-orthodontic phase. SEARCH METHODS MEDLINE via PubMed was searched to identify all peer-reviewed articles potentially relevant to the review until 1 July 2018. Relevant publications were selected by two reviewers independently. SELECTION CRITERIA The literature selection for this systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was based on predetermined inclusion criteria. DATA COLLECTION AND ANALYSIS Data were collected on overall study characteristics and examination characteristics of the selected studies. Methodological quality of the selected studies was evaluated. Original studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Thereafter, levels of evidence were obtained according to Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS As a result of the QUADAS assessment, a total of 37 articles were included in the protocol. Following a proper protocol, CBCT was regarded as a reliable tool for assessment and management of impacted canine and root fracture. It provided a better evaluation of normal and pathological condylar shape and volume. CBCT was a superior choice for pre-surgical diagnostic applications in cleft lip and/or palate over a medical computed tomography based on its lower radiation exposure, shorter investigation time, and low purchase costs. CONCLUSIONS CBCT is justified only in those cases where conventional radiography fails to provide a correct diagnosis of pathology. Therefore, it cannot be regarded as a standard method of diagnosis. CBCT imaging may also be justified when it positively affects treatment options or provides treatment optimization. REGISTRATION None. CONFLICT OF INTEREST None to declare.
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Affiliation(s)
- Annelore De Grauwe
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Katholieke Universiteit Leuven.,DentoMaxillofacial Radiology Center, University Hospitals Leuven, Leuven, Belgium
| | - Irem Ayaz
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Katholieke Universiteit Leuven.,DentoMaxillofacial Radiology Center, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Katholieke Universiteit Leuven.,DentoMaxillofacial Radiology Center, University Hospitals Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Katholieke Universiteit Leuven.,DentoMaxillofacial Radiology Center, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Pawlaczyk-Kamieńska T, Kulczyk T, Pawlaczyk-Wróblewska E, Borysewicz-Lewicka M, Niedziela M. Limited Mandibular Movements as a Consequence of Unilateral or Asymmetrical Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis Patients. J Clin Med 2020; 9:E2576. [PMID: 32784489 PMCID: PMC7465506 DOI: 10.3390/jcm9082576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022] Open
Abstract
This study aimed to assess the asymmetry of the lower face and motor dysfunction of the masticatory system resulting from unilateral or asymmetrical bilateral temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) patients. The study consisted of clinical examination and cone beam computed tomography (CBCT) of TMJs. Statistical analysis showed correlations between several factors: facial asymmetry and mandibular lateral deviation; the direction of mandibular deviation and the degree of radiological deformities in TMJs; the child's age at the time of the onset and the range of lateral movement towards the healthy or less destructed joint. In addition, there was a significant difference in ranges of lateral movements; a significantly smaller range was observed for the joint with fewer condylar abnormalities compared to the range in the opposite direction. In JIA children, among the clinical markers of unilateral or asymmetrical TMJ involvement, the asymmetry of the lower face, deviation of the mandible on opening, and an uneven range of mandibular lateral movements deserve attention. The obtained results do not show a relationship between the degree of condylar changes and the asymmetry of the lower face and the presence and degree of mandibular motor dysfunction.
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Affiliation(s)
- Tamara Pawlaczyk-Kamieńska
- Department of Risk Group Dentistry, Chair of Pediatric Dentistry, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Tomasz Kulczyk
- Section of Dental Radiology, Department of Biomaterials and Experimental Dentistry, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Elżbieta Pawlaczyk-Wróblewska
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (E.P.-W.); (M.N.)
| | - Maria Borysewicz-Lewicka
- Department of Risk Group Dentistry, Chair of Pediatric Dentistry, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (E.P.-W.); (M.N.)
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Ortún-Terrazas J, Fagan MJ, Cegoñino J, Illipronti-Filho E, Pérez Del Palomar A. Towards an early 3D-diagnosis of craniofacial asymmetry by computing the accurate midplane: A PCA-based method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 191:105397. [PMID: 32092615 DOI: 10.1016/j.cmpb.2020.105397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/11/2020] [Accepted: 02/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Craniofacial asymmetry is a common growth disorder often caused by unilateral chewing. Although an early orthodontic treatment would avoid surgical procedures later in life, the uncertainty of defining the accurate sagittal midplane potentially leads to misdiagnosis and therefore inaccurate orthodontic treatment plans. This novel study aims to 3D-diagnose craniofacial complex malformations in children with unilateral crossbite (UXB) considering a midplane which compensates the asymmetric morphology. METHODS The sagittal midplane of 20 children, fifteen of whom exhibited UXB, was computed by a PCA-based method which compensates the asymmetry mirroring the 3D models obtained from cone-beam computed tomography data. Once determined, one side of the data was mirrored using the computed midplane to visualize the malformations on the hard and soft tissues by 3D-computing the distances between both halves. Additionally, 31 skull's landmarks were manually placed in each model to study the principal variation modes and the significant differences in the group of subjects with and without UXB through PCA and Mann-Whitney U test analyses respectively. RESULTS Morphological 3D-analysis showed pronounced deformities and aesthetic implications for patients with severe asymmetry (jaw deviation > 0.8 mm) in whole craniofacial system, while initial signs of asymmetry were found indistinctly in the mandible or maxilla. We detected significant (p < 0.05) malformations for example in mandibular ramus length (0.0086), maxillary palate width (0.0481) and condylar head width (0.0408). Craniofacial malformations increased the landmarks' variability in the group of patients with UXB over the control group requiring 8 variation modes more to define 99% of the sample' variability. CONCLUSIONS Our findings demonstrated the viability of early diagnosis of craniofacial asymmetry through computing the accurate sagittal midplane which compensates the individual's asymmetrical morphology. Furthermore, this study provides important computational insights into the determination of craniofacial deformities which are caused by UXB, following some empirical findings of previous clinical studies. Hence, this computational approach can be useful for the development of new software in craniofacial surgery or for its use in biomedical research and clinical practice.
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Affiliation(s)
- Javier Ortún-Terrazas
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.
| | - Michael J Fagan
- Medical and Biological Engineering, School of Engineering and Computer Science, University of Hull, Hull, United Kingdom
| | - Jose Cegoñino
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Edson Illipronti-Filho
- School of Dentistry, Department of Orthodontics and Pediatric Dentistry, University of São Paulo, São Paulo, Brazil
| | - Amaya Pérez Del Palomar
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
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Assessment of condylar volume and ramus height in JIA patients with unilateral and bilateral TMJ involvement: retrospective case-control study. Clin Oral Investig 2019; 24:2635-2643. [PMID: 31760476 DOI: 10.1007/s00784-019-03122-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objectives of the study are to analyze volumetric differences of condylar volumes in patients with unilateral and bilateral JIA and to compare results with control condylar volumes. MATERIALS AND METHODS Forty-six CBCT images were analyzed for all patients affected by JIA, 37 females and 9 males (mean age 10.8 ± 4.2) with TMJ involvement (19 unilaterally, mean age 10.9 ± 4.5; 27 bilaterally, mean age 10.7 ± 4.5), and 25 CBCT of subjects without diagnosis of JIA were selected as controls (mean age 10.8 ± 4.2 years). In the case of unilateral JIA, condylar volumes and ramus lengths were compared with healthy condyle and with the compromised one. In the case of bilateral JIA, condyle volume and ramus lengths were compared with healthy one. The Shapiro-Wilk test was used to assess whether the data was normally distributed. Paired t test was applied to compare affected and non-affected condyle in the same patients (P < 0.05). Independent t test was used to evaluate whether the difference between the groups were comparable or significantly different (P < 0.05). RESULTS For the unilateral JIA group, significant differences comparing affected and non-affected condyles were found. A statistically significant reduction of the volume of the head, neck, and ramus was found in the affected side (P < 0.01). For the bilateral JIA group, statistically significant differences have been found considering the condylar head and neck, the whole condylar volume, and the ramus length compared with the control group (P < 0.05). CONCLUSIONS Subjects with unilateral JIA have condyles volumetrically smaller than those of the unaffected side and those found in healthy patients. A considerable decrease of the volume of all the anatomical structures considered in the patients with bilateral JIA was found compared with control group. CLINICAL RELEVANCE The study presents the effects of JIA on different anatomical structures highlighting their dimensional changes, whose sequelae are irreversible if not diagnosed and treated early.
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Lee Y, Hong IK, Chun Y. Prediction of painful temporomandibular joint osteoarthritis in juvenile patients using bone scintigraphy. Clin Exp Dent Res 2019; 5:225-235. [PMID: 31249703 PMCID: PMC6585587 DOI: 10.1002/cre2.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022] Open
Abstract
The study aims to evaluate whether bone scintigraphy is effective in diagnosing temporomandibular joint (TMJ) osteoarthritis (OA) in juvenile patients. A retrospective study was conducted with 356 consecutive patients with TMJ-OA who were clinically assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Patients were assigned to three groups based on their ages: Group 1: aged 12-16 years; Group 2: aged 17-19 years; and Group 3: aged 20 years. Additionally, we performed qualitative and quantitative analyses of bone scintigraphy images for the TMJ uptake ratio of the involved joint. The diagnostic rate of TMJ-OA (n = 356, 100%), and the overall presence of subjective pain (n = 282, 77.3%) was closest to the results of bone scintigraphy (n = 333, 91.2%). In addition, reported TMJ pain was significantly associated only with the results of bone scintigraphy and not with the results of panoramic radiography or cone beam computed tomography (CBCT) in all age groups. With CBCT as the reference standard, the optimal cutoff values of the uptake ratio for the diagnosis of TMJ-OA were 2.171 and 2.017 in Groups 1 and 2, respectively (P value < 0.05). Our results suggest that bone scintigraphy can be considered a useful modality for diagnosing TMJ-OA in juvenile patients.
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Affiliation(s)
- Yeon‐Hee Lee
- Department of Orofacial Pain and Oral MedicineKyung Hee University Dental HospitalSeoulSouth Korea
| | - Il Ki Hong
- Department of Nuclear MedicineKyung Hee University College of Medicine, Kyung Hee University HospitalSeoulSouth Korea
| | - Yang‐Hyun Chun
- Department of Orofacial Pain and Oral MedicineKyung Hee University Dental HospitalSeoulSouth Korea
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Isola G, Perillo L, Migliorati M, Matarese M, Dalessandri D, Grassia V, Alibrandi A, Matarese G. The impact of temporomandibular joint arthritis on functional disability and global health in patients with juvenile idiopathic arthritis. Eur J Orthod 2019; 41:117-124. [PMID: 29878100 DOI: 10.1093/ejo/cjy034] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of the study was to evaluate the impact of temporomandibular joint (TMJ) arthritis on the functional disability and quality of life in patients affected by juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS Sixty-two consecutive patients with JIA with or without TMJ arthritis and 35 healthy control subjects were enrolled in the study. The demographic data, disease activity and clinical characteristics were obtained from all patients. The functional disability was assessed using the Italian version of the Childhood Health Assessment Questionnaire (C-HAQ). The oral health-related quality of life (OHRQoL) was assessed using the Child Perception Questionnaire (CPQ11-14). Possible determining factors of TMJ arthritis comprised demographic, disease characteristics and scores derived from questionnaires that were assessed by a uni and multivariable logistic regression analysis. RESULTS Compared with patients without TMJs arthritis, JIA patients with TMJ arthritis presented higher functional disability. The multivariable logistic regression analysis performed showed that female subjects (OR = 1.5, P = 0.041), with a JIA duration over 3.9 years (OR = 2.7, P = 0.033) and presenting higher C-HAQ and CPQ11-14 scores (OR = 2.7, P = 0.012 and OR = 2.9, P = 0.015, respectively) were the greatest determining factors for TMJ arthritis. CONCLUSIONS JIA patients with TMJ arthritis presented higher functional disability and lower OHRQoL scores compared with JIA patients without TMJ arthritis. TMJ arthritis was strongly associated with JIA duration and activity, especially in female patients.
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Affiliation(s)
- Gaetano Isola
- Department of Biomedical, Odontostomatological, Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Italy
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Italy
| | | | - Marco Matarese
- Department of Biomedical, Odontostomatological, Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Italy
| | | | - Vincenzo Grassia
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Italy
| | - Giovanni Matarese
- Department of Biomedical, Odontostomatological, Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, Italy
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Mendoza LV, Bellot-Arcís C, Montiel-Company JM, García-Sanz V, Almerich-Silla JM, Paredes-Gallardo V. Linear and Volumetric Mandibular Asymmetries in Adult Patients With Different Skeletal Classes and Vertical Patterns: A Cone-Beam Computed Tomography Study. Sci Rep 2018; 8:12319. [PMID: 30120301 PMCID: PMC6098024 DOI: 10.1038/s41598-018-30270-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022] Open
Abstract
This study aimed to quantify the height of the mandibular condyle and ramus, condylar volume, and the asymmetry index in adult patients of different sex, skeletal class and vertical pattern using Cone-Beam Computed Tomography (CBCT), and to determine whether there were differences between these groups. The study used CBCT scans of 159 patients with a mean age of 32.32 ± 8.31 years. InVivoDental® software was used to perform both linear (condylar, ramal, and total height) and condylar volume measurements. Linear and volumetric asymmetries were calculated. There were not significant differences between right and left sides. The mean value obtained for condyle height was 7.27 mm, ramus height 42.3 mm, total height 49.6 mm and condyle volume 1907.1 mm3, with significant differences between men and women. Significantly higher values were found for condylar volume in hypodivergent patterns (p = 0.001) and for the asymmetry index of the condylar volume in Class II patients (p < 0.05). The prevalence of relevant asymmetry was high for condyle height and volume (73.1% y 75.6% respectively). Higher height and volume values were found among men, Class III, and hypodivergent patients. Linear and volumetric asymmetries were more prevalent among men, Class III and hyperdivergent patterns.
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Affiliation(s)
- Luz Victoria Mendoza
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Carlos Bellot-Arcís
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José María Montiel-Company
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
| | - Verónica García-Sanz
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José Manuel Almerich-Silla
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Economou S, Stoustrup P, Kristensen KD, Dalstra M, Küseler A, Herlin T, Pedersen TK. Evaluation of facial asymmetry in patients with juvenile idiopathic arthritis: Correlation between hard tissue and soft tissue landmarks. Am J Orthod Dentofacial Orthop 2018; 153:662-672.e1. [DOI: 10.1016/j.ajodo.2017.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 11/27/2022]
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17
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No association between types of unilateral mandibular condylar abnormalities and facial asymmetry in orthopedic-treated patients with juvenile idiopathic arthritis. Am J Orthod Dentofacial Orthop 2018; 153:214-223. [DOI: 10.1016/j.ajodo.2017.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
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Temporomandibular Joint Anatomy Assessed by CBCT Images. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2916953. [PMID: 28261607 PMCID: PMC5312052 DOI: 10.1155/2017/2916953] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/28/2016] [Indexed: 11/18/2022]
Abstract
Aim. Since cone beam computed tomography (CBCT) has been used for the study of craniofacial morphology, the attention of orthodontists has also focused on the mandibular condyle. The purpose of this brief review is to summarize the recent 3D CBCT images of mandibular condyle. Material and Methods. The eligibility criteria for the studies are (a) studies aimed at evaluating the anatomy of the temporomandibular joint; (b) studies performed with CBCT images; (c) studies on human subjects; (d) studies that were not clinical case-reports and clinical series; (e) studies reporting data on children, adolescents, or young adults (data from individuals with age ≤ 30 years). Sources included PubMed from June 2008 to June 2016. Results. 43 full-text articles were initially screened for eligibility. 13 full-text articles were assessed for eligibility. 11 articles were finally included in qualitative synthesis. The main topics treated in the studies are the volume and surface of the mandibular condyle, the bone changes on cortical surface, the facial asymmetry, and the optimum position of the condyle in the glenoid fossa. Conclusion. Additional studies will be necessary in the future, constructed with longitudinal methodology, especially in growing subjects. The limits of CBCT acquisitions are also highlighted.
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Comparative Evaluation of Condylar Volume Between Patients With Unilateral Condylar Hyperplasia and Class III Dentofacial Deformity. J Oral Maxillofac Surg 2017; 75:180-188. [DOI: 10.1016/j.joms.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 11/18/2022]
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Otero González MF, Pedersen TK, Dalstra M, Herlin T, Verna C. 3D evaluation of mandibular skeletal changes in juvenile arthritis patients treated with a distraction splint: A retrospective follow-up. Angle Orthod 2016; 86:846-853. [PMID: 27003225 PMCID: PMC8600825 DOI: 10.2319/081715-549.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 12/01/2015] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To evaluate three-dimensional (3D) condylar and mandibular growth in patients with juvenile idiopathic arthritis (JIA) with unilateral temporomandibular joint involvement treated with a distraction splint. MATERIALS AND METHODS Cone-beam computed tomography (CBCT) scans were taken for 16 patients with JIA with unilateral TMJ involvement before treatment (T0) and 2 years after treatment (T1). All patients received orthopedic treatment with a distraction splint. Eleven patients without JIA who were undergoing orthodontic treatment without a functional appliance or Class II mechanics and who had taken CBCT scans before and after treatment, served as controls. Reconstructed 3D models of the mandibles at T0 and T1 were superimposed on stable structures. Intra- and intergroup growth differences in condylar and mandibular ramus modifications and growth vector direction of the mandibular ramus were evaluated. RESULTS In all patients with JIA there were asymmetric condylar volume, distal and vertical condylar displacement, and ramus length differences that were smaller on the affected side. Condylar displacement was more distal and less vertical in the JIA group than in the control group. A larger distal growth of the condylar head and a more medial rotation of the ramus on the affected side were found in the JIA group. CONCLUSION The orthopedic functional treatment for patients with JIA allows for condylar adaptation and modeling, thereby hindering, although with a widely variable response, a further worsening of the asymmetry. Unilateral affection has a possible influence on the growth of the nonaffected side.
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Affiliation(s)
- Maria Florinda Otero González
- PhD student, Centro Singular de Investigación en Tecnoloxías da Información (CITIUS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Thomas Klit Pedersen
- Professor, Section of Orthodontics, Institute of Odontology, Aarhus University and Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Michel Dalstra
- Associate Professor, Section of Orthodontics, Institute of Odontology, Aarhus University, Aarhus, Denmark
| | - Troels Herlin
- Professor, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Carlalberta Verna
- Professor and Head, Department of Orthodontics and Pediatric Dentistry, University of Basel, Basel, Switzerland, and Visiting Professor, Section of Orthodontics, Institute of Odontology, Aarhus University, Aarhus, Denmark
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Pauwels R, Jacobs R, Bogaerts R, Bosmans H, Panmekiate S. Determination of size-specific exposure settings in dental cone-beam CT. Eur Radiol 2016; 27:279-285. [PMID: 27108296 DOI: 10.1007/s00330-016-4353-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/15/2016] [Accepted: 04/05/2016] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To estimate the possible reduction of tube output as a function of head size in dental cone-beam computed tomography (CBCT). METHODS A 16 cm PMMA phantom, containing a central and six peripheral columns filled with PMMA, was used to represent an average adult male head. The phantom was scanned using CBCT, with 0-6 peripheral columns having been removed in order to simulate varying head sizes. For five kV settings (70-90 kV), the mAs required to reach a predetermined image noise level was determined, and corresponding radiation doses were derived. Results were expressed as a function of head size, age, and gender, based on growth reference charts. RESULTS The use of 90 kV consistently resulted in the largest relative dose reduction. A potential mAs reduction ranging from 7 % to 50 % was seen for the different simulated head sizes, showing an exponential relation between head size and mAs. An optimized exposure protocol based on head circumference or age/gender is proposed. CONCLUSIONS A considerable dose reduction, through reduction of the mAs rather than the kV, is possible for small-sized patients in CBCT, including children and females. Size-specific exposure protocols should be clinically implemented. KEY POINTS • Fixed exposure settings in CBCT results in overexposure for smaller patients • For children, considerable dose reduction is possible without compromising image quality • A reduction in mAs is more dose-efficient than a kV reduction • An optimized exposure protocol was proposed based on phantom measurements • This protocol should be validated in a clinical setting.
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Affiliation(s)
- Ruben Pauwels
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Rd, Patumwan, 10330, Bangkok, Thailand. .,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium.
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Ria Bogaerts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Hilde Bosmans
- Medical Physics & Quality Assessment, Department of Imaging and Pathology, Biomedical Sciences Group, University of Leuven, Leuven, Belgium
| | - Soontra Panmekiate
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Rd, Patumwan, 10330, Bangkok, Thailand
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El Assar de la Fuente S, Angenete O, Jellestad S, Tzaribachev N, Koos B, Rosendahl K. Juvenile idiopathic arthritis and the temporomandibular joint: A comprehensive review. J Craniomaxillofac Surg 2016; 44:597-607. [PMID: 26924432 DOI: 10.1016/j.jcms.2016.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/12/2015] [Accepted: 01/26/2016] [Indexed: 11/29/2022] Open
Abstract
Juvenile idiopathic arthritis is the most common inflammatory rheumatic disease of childhood and represents a series of chronic inflammatory arthritides of unknown cause. Involvement of the temporomandibular joint has been reported in up to 87% of children with juvenile idiopathic arthritis when based on magnetic tomography imaging; it can be asymptomatic and may lead to severe long term complications. In this review a summary of the contemporary literature of imaging of the temporomandibular joint in children with juvenile idiopathic arthritis will be provided, including ultrasound which is a valuable method for guided joint injections, but does not necessarily allow detection of acute inflammation, cone beam computed tomography, which has emerged as a feasible and accurate low-dose alternative as compared to conventional computed tomography to detect destructive change, and magnetic resonance imaging which is considered the method of choice for assessing acute, inflammatory change, although the lack of normative standards remains a challenge in children.
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Affiliation(s)
| | - O Angenete
- Department of Radiology, St Olav University Hospital, Norway
| | - S Jellestad
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - N Tzaribachev
- Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - B Koos
- Department of Orthodontics, University of Rostock, Germany
| | - K Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; University of Bergen, Department of Clinical Medicine K1, Norway.
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Piancino MG, Cannavale R, Dalmasso P, Tonni I, Filipello F, Perillo L, Cattalini M, Meini A. Condylar asymmetry in patients with juvenile idiopathic arthritis: Could it be a sign of a possible temporomandibular joints involvement? Semin Arthritis Rheum 2015; 45:208-13. [DOI: 10.1016/j.semarthrit.2015.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/27/2015] [Accepted: 04/27/2015] [Indexed: 11/29/2022]
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Larheim TA, Abrahamsson AK, Kristensen M, Arvidsson LZ. Temporomandibular joint diagnostics using CBCT. Dentomaxillofac Radiol 2015; 44:20140235. [PMID: 25369205 DOI: 10.1259/dmfr.20140235] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The present review will give an update on temporomandibular joint (TMJ) imaging using CBCT. It will focus on diagnostic accuracy and the value of CBCT compared with other imaging modalities for the evaluation of TMJs in different categories of patients; osteoarthritis (OA), juvenile OA, rheumatoid arthritis and related joint diseases, juvenile idiopathic arthritis and other intra-articular conditions. Finally, sections on other aspects of CBCT research related to the TMJ, clinical decision-making and concluding remarks are added. CBCT has emerged as a cost- and dose-effective imaging modality for the diagnostic assessment of a variety of TMJ conditions. The imaging modality has been found to be superior to conventional radiographical examinations as well as MRI in assessment of the TMJ. However, it should be emphasized that the diagnostic information obtained is limited to the morphology of the osseous joint components, cortical bone integrity and subcortical bone destruction/production. For evaluation of soft-tissue abnormalities, MRI is mandatory. There is an obvious need for research on the impact of CBCT examinations on patient outcome.
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Affiliation(s)
- T A Larheim
- 1 Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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Larheim TA, Doria AS, Kirkhus E, Parra DA, Kellenberger CJ, Arvidsson LZ. TMJ imaging in JIA patients—An overview. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Peltomäki T, Kreiborg S, Pedersen TK, Ogaard B. Craniofacial growth and dento-alveolar development in juvenile idiopathic arthritis patients. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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ILLIPRONTI-FILHO E, FANTINI SM, CHILVARQUER I. Evaluation of mandibular condyles in children with unilateral posterior crossbite. Braz Oral Res 2015; 29:49. [DOI: 10.1590/1807-3107bor-2015.vol29.0049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/10/2014] [Indexed: 11/22/2022] Open
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Pathological changes in the TMJ and the length of the ramus in patients with confirmed juvenile idiopathic arthritis. J Craniomaxillofac Surg 2014; 42:1802-7. [DOI: 10.1016/j.jcms.2014.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/01/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
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Kasimoglu Y, Tuna EB, Rahimi B, Marsan G, Gencay K. Condylar asymmetry in different occlusion types. Cranio 2014; 33:10-4. [DOI: 10.1179/0886963414z.00000000039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Yildirim E, Karacay S, Erkan M. Condylar response to functional therapy with Twin-Block as shown by cone-beam computed tomography. Angle Orthod 2014; 84:1018-25. [PMID: 24713070 DOI: 10.2319/112713-869.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the condylar changes through cone-beam computed tomography (CBCT) images in patients treated with Twin-Block functional appliance. MATERIALS AND METHODS In this retrospective study, CBCT images of 30 patients who were treated with the Twin-Block appliance were used. Mandible was segmented and pretreatment and posttreatment (T0 and T1) condylar volume was compared. The angle between sella-nasion-Point A (SNA), angle between sella-nasion-Point B (SNB), angle between Point A-nasion-Point B (ANB), midfacial length (Co-A), mandibular length (Co-Gn), and the distances from right condylion to left condylion (CoR-CoL) were also measured on three-dimensional images. Differences were analyzed with Wilcoxon signed rank tests, and Mann-Whitney U-tests were used to compare the scores of male and female participants. Significance was set at P < .05. RESULTS In this study, a decrease in SNA and ANB (P < .05 and P < .01, respectively) and an increase in SNB (P < .01) were found. Additionally, CoR-CoL, Co-Gn, and condylar volume increased at both the left and right sides (P < .01). However, increase at Co-A was not statistically significant (P > .05). Comparison of differences by sex was not statistically significant for all measurements (P > .05). CONCLUSION Twin-Block appliance increases condylar volume, mandibular length, and intercondylar distance by stimulating growth of condyle in an upward and backward direction.
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Affiliation(s)
- Ersin Yildirim
- a Assistant Professor, Gülhane Military Medical Academy Haydarpasha Education Hospital, Dental Service, Section of Orthodontics, Istanbul, Turkey
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Koos B, Tzaribachev N, Bott S, Ciesielski R, Godt A. Classification of temporomandibular joint erosion, arthritis, and inflammation in patients with juvenile idiopathic arthritis. J Orofac Orthop 2013; 74:506-19. [PMID: 24173363 DOI: 10.1007/s00056-013-0166-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 01/30/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis is the most common disease in pediatric rheumatology. It is characterized by chronically progressive joint destruction. The temporomandibular joints (TMJs) are involved in up to 87% of patients and may take an asymptomatic course in 69% of cases. Other than contrast-enhanced magnetic resonance imaging (MRI), there are no reliable screening symptoms or non-invasive procedures available to diagnose the inflammation in its acute form. The goal of this study was to establish an imaging-based classification system for TMJ erosion via MRI and cone-beam computed tomography (CBCT) in an effort to improve indication-specific treatment approaches and to facilitate the comparison of findings. MATERIALS AND METHODS A total of 46 patients were included. Contrast-enhanced MRI and CBCT images obtained during treatment by pediatric rheumatologists and orthodontists were available from 23 patients with juvenile idiopathic arthritis. We devised a classification system combining the findings of both imaging techniques based on this patient sample in comparison with CBCT findings from an age- and gender-matched group of 23 non-arthritis patients, taking into consideration the available literature and administration of contrast medium. RESULTS Our cohort of 46 patients comprised 60% female and 40% male patients with a mean age of 14 years, providing a total of 92 TMJs for evaluation. We were able to apply the findings efficiently and conveniently to this classification system with no relevant interobserver differences. Mild structural abnormalities were noted in 21% of TMJs in the control group, whereas 83% of TMJs in the arthritis group exhibited severe anomalies, including cases of extreme destruction. Age and gender did not affect the degree of destruction significantly. CONCLUSION This is the first classification system to link CBCT and MRI with the use of contrast medium. Contrast-enhanced MRI is an internationally recognized technique that permits acute inflammation to be unequivocally diagnosed. Although structural erosion of the TMJs in our arthritis group was generally severe and significant, we were surprised to observe some cases that were clinically asymptomatic.
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Affiliation(s)
- B Koos
- Department of Orthodontics, University Hospital of Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany,
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Zhang Y, Che B, Ni Y, Zhang H, Pan Y, Wang L, Ma J. Three-dimensional condylar positions and forms associated with different anteroposterior skeletal patterns and facial asymmetry in Chinese adolescents. Acta Odontol Scand 2013; 71:1174-80. [PMID: 23294119 DOI: 10.3109/00016357.2012.757359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the association of condylar asymmetry and chin position with different anteroposterior skeletal patterns using three-dimensional models reconstructed from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS CBCT scans of 123 Chinese adolescents (aged 11-15 years, 68 girls and 55 boys) with 64 skeletal Class I, 46 Class II and 13 Class III were selected from scans of patients attending the orthodontic clinic. The condyles of the subjects were reconstructed bilaterally and 25 linear, angular and volumetric measurements were performed to evaluate the asymmetry of the condyles and position of the chin. The proportions of condylar asymmetry in the different skeletal groups were calculated by the absolute difference value between the left and right sides to the smaller side value. One-way analysis of variance and Pearson's correlations were used to analyse the data. RESULTS The values for RV, RCL, LCH, RCH, LCGM, RCGM, LCo-Me and RCo-Me were significantly different among the three skeletal groups (p < 0.05). There were significant positive correlations between Pog-Ss and Co-Sh, Co-Me in the Class I and II groups (p < 0.05). Asymmetries for Co-Ss, Co-Sh, CP and SP between the left and right condyles exceeded a ratio of 20% for more than 30% of the subjects. CONCLUSION Condylar asymmetry varied significantly among the three skeletal groups, with the vertical position of the condyle (Co-Sh) and height of the mandibular ramus (Co-Me) being significantly and positively related to the chin position.
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Affiliation(s)
- Yang Zhang
- Institute of Stomatology, Nanjing Medical University, Nanjing, PR, China.
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Assaf AT, Kahl-Nieke B, Feddersen J, Habermann CR. Is high-resolution ultrasonography suitable for the detection of temporomandibular joint involvement in children with juvenile idiopathic arthritis? Dentomaxillofac Radiol 2013; 42:20110379. [PMID: 23439686 DOI: 10.1259/dmfr.20110379] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the potential of high-resolution ultrasonography for the detection of temporomandibular joint (TMJ) changes in children with juvenile idiopathic arthritis (JIA). METHODS We investigated prospectively 20 children (17 female and 3 male; mean age 11.06 years, standard deviation 3.43 years) with TMJ disorders caused by JIA, over a period of 16 months. Using a 12 MHz array transducer, four images in each TMJ (160 images) were acquired. Each image was analysed with regard to five different aspects (condylar erosion, thickness of the condylar disc, synovial thickness, joint effusion and enlargement of the intra-articular space). RESULTS Diagnosis of JIA was ensured for every child and involvement of the TMJ was proven by MRI. Overall 287 changes (35.9%) were detected by using high-resolution ultrasonography. On 124 images (77.5%) condylar erosions were diagnosed; on 55 images (34.4%) synovial thickness was abnormal; on 48 images (30%) we could see higher thickness of the condylar disc; on 40 images (25%) irregularities of the bony surface were detected; and on 20 images (12.5%) we found joint effusion. CONCLUSION High-resolution ultrasonography could be a sufficient diagnostic method, especially for the detection of condylar involvement in children with JIA, even if not all parts of the TMJ are visible for ultrasonography. High-resolution ultrasonography is a valuable tool in particular situations: (i) when MRI examination is not available; (ii) when children fear MRI examination; (iii) in more advanced stages of JIA; and (iv) for monitoring the progression of TMJ involvement and response of therapy.
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Affiliation(s)
- A T Assaf
- Department of Oral and Cranio- Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Hamburg, Germany.
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Abstract
Radiographic examination forms an integral component of the clinical assessment routine in patients with temporomandibular joint disorders (TMJ). There are several imaging modalities to visualize the TMJ. Cone beam computed tomography (CBCT) is a developing technique that is being increasingly used in dentomaxillofacial imaging due to its relatively low-dose high-spatial-resolution characteristics. Research in TMJ imaging has been greatly inspired by the advent of CBCT. In this paper we aim to discuss the present scenario of the role of CBCT in TMJ imaging.
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Affiliation(s)
- Bhuvana Krishnamoorthy
- Department of Oral Medicine and Radiology, ITS-Centre of Dental Sciences and Research, Delhi-Meerut Road, Muradnagar, Ghaziabad, Uttar Pradesh, India
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Bayome M, Park JH, Kook YA. New three-dimensional cephalometric analyses among adults with a skeletal Class I pattern and normal occlusion. Korean J Orthod 2013; 43:62-73. [PMID: 23671831 PMCID: PMC3650215 DOI: 10.4041/kjod.2013.43.2.62] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to assess new three-dimensional (3D) cephalometric variables, and to evaluate the relationships among skeletal and dentoalveolar variables through 3D cephalometric analysis. Methods Cone-beam computed tomography (CBCT) scans were acquired from 38 young adults (18 men and 20 women; 22.6 ± 3.2 years) with normal occlusion. Thirty-five landmarks were digitized on the 3D-rendered views. Several measurements were obtained for selected landmarks. Correlations among different variables were calculated by means of Pearson's correlation coefficient values. Results The body of the mandible had a longer curve length in men (102.3 ± 4.4 mm) than in women (94.5 ± 4.7 mm) (p < 0.001), but there was no significant difference in the maxillary basal curve length. Men had significantly larger facial dimensions, whereas women had a larger gonial angle (117.0 ± 4.0 vs. 113.8 ± 3.3; p < 0.001). Strong-to-moderate correlation values were found among the vertical and transverse variables (r = 0.71 to 0.51). Conclusions The normative values of new 3D cephalometric parameters, including the maxillary and mandibular curve length, were obtained. Strong-to-moderate correlation values were found among several vertical and transverse variables through 3D cephalometric analysis. This method of cephalometric analyses can be useful in diagnosis and treatment planning for patients with dentofacial deformities.
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Affiliation(s)
- Mohamed Bayome
- Graduate School, The Catholic University of Korea, Seoul, Korea
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Ferraz Júnior AML, Devito KL, Guimarães JP. Temporomandibular disorder in patients with juvenile idiopathic arthritis: clinical evaluation and correlation with the findings of cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e51-7. [DOI: 10.1016/j.oooo.2012.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/15/2012] [Accepted: 02/21/2012] [Indexed: 01/24/2023]
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Yáñez-Vico RM, Iglesias-Linares A, Torres-Lagares D, Gutiérrez-Pérez JL, Solano-Reina E. Association between condylar asymmetry and temporomandibular disorders using 3D-CT. Med Oral Patol Oral Cir Bucal 2012; 17:e852-8. [PMID: 22322511 PMCID: PMC3482533 DOI: 10.4317/medoral.17786] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/05/2011] [Indexed: 11/06/2022] Open
Abstract
Objectives: Using reconstructed three-dimensional computed tomography (3D-CT) models, the purpose of this study was to analyze and compare mandibular condyle morphology in patients with and without temporomandibular disorder (TMD).
Study Design: Thirty-two patients were divided into two groups: the first comprised those with TMD (n=18), and the second those who did not have TMD (n=14). A CT of each patient was obtained and reconstructed as a 3D model. The 64 resulting 3D condylar models were evaluated for possible TMD-associated length, width and height asymmetries of the condylar process. Descriptive statistics were used to assess the results and student’s t tests applied to compare the two groups.
Results: Statistically significant (p<0.05) vertical, mediolateral and sagittal asymmetries of the condylar process were observed between TMD and non-TMD groups. TMD patients showed less condylar height (p<0.05) in comparison with their asymptomatic counterparts.
Conclusions: Using 3D-CT, it was shown that condylar width, height and length asymmetries were a common feature of TMD.
Key words:Condilar asymmetry, 3D-computed tomography, X-ray diagnosis , maxillofacial surgery, orthodontics.
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Affiliation(s)
- Rosa-María Yáñez-Vico
- Department of Stomatology, University of Seville, School of Dentistry of Seville, C/ Avicena s/n 41009, Seville, Spain.
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Volumetric analysis of the mandibular condyle using cone beam computed tomography. Eur J Radiol 2012; 81:1812-6. [DOI: 10.1016/j.ejrad.2011.04.070] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/04/2011] [Indexed: 11/19/2022]
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Kjellberg H, Pavlou I. Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs: a case control study. Angle Orthod 2011; 81:447-452. [PMID: 21261481 PMCID: PMC8923539 DOI: 10.2319/060310-302.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/01/2010] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To evaluate whether plain lateral cephalometric radiographs in the neutral position could be used as a diagnostic tool to investigate changes in the cervical spine related to juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS Lateral cephalometric radiographs of 82 subjects, 21 males and 61 females (8-25 years old), affected with JIA were revised and compared with 82 healthy control subjects matched in age and gender. Changes inspected in the cervical spine were erosions of the dens and fusion of the apophyseal joints. Anterior atlantoaxial subluxation of the first vertebra in relation to the second was examined by measuring the anterior atlanto-dens interval (aADI). Atlantoaxial impaction (AAI) was studied by using the Sakaguchi-Kauppi method. RESULTS In the JIA sample, erosion was seen in 14.7%, (12 patients), of the patients and apophyseal joint ankylosis (fusion) in 18.3%, (15 patients). Three children and one adult had aADI more than 4.5 or 3 mm, respectively, which is considered to be abnormally increased, and AAI was noted in 13.0% of the subjects. In total, 35%, (29 children), of the children with JIA showed one or several radiographically visible changes as described earlier. Two of the control subjects showed ankylosis of the apophyseal joints, and one had aADI of 4 mm. Compared with the controls, significantly more changes were found in the JIA group. CONCLUSION It can be concluded that arthritic changes in the cervical spine can be detected at a young age on plain lateral cephalometric radiographs and should be evaluated when available.
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Affiliation(s)
- Heidrun Kjellberg
- Institution of Odontology, Department of Orthodontics, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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Tecco S, Saccucci M, Nucera R, Polimeni A, Pagnoni M, Cordasco G, Festa F, Iannetti G. Condylar volume and surface in Caucasian young adult subjects. BMC Med Imaging 2010; 10:28. [PMID: 21194477 PMCID: PMC3019198 DOI: 10.1186/1471-2342-10-28] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 12/31/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been no quantitative standards for volumetric and surface measurements of the mandibular condyle in Caucasian population. However, the recently developed cone-beam computed tomography (CBCT) system allows measurement of these parameters with high accuracy. METHODS CBCT was used to measure the condylar volume, surface and the volume to surface ratio, called the Morphometric Index (MI), of 300 temporo-mandibular joints (TMJ) in 150 Caucasian young adult subjects, with varied malocclusions, without pain or dysfunction of TMJs. RESULTS The condylar volume was 691.26 ± 54.52 mm3 in males and 669.65 ± 58.80 mm3 in, and was significantly higher (p< 0.001) in the males. The same was observed for the condylar surface, although without statistical significance (406.02 ± 55.22 mm2 in males and 394.77 ± 60.73 mm2 in females).Furthermore, the condylar volume (693.61 ± 62.82 mm3 ) in the right TMJ was significantly higher than in the left (666.99 ± 48.67 mm3, p < 0.001) as was the condylar surface (411.24 ± 57.99 mm2 in the right TMJ and 389.41 ± 56.63 mm2 in the left TMJ; t = 3.29; p < 0.01). The MI is 1.72 ± 0.17 for the whole sample, with no significant difference between males and females or the right and left sides. CONCLUSION These data from temporomandibular joints of patients without pain or clinical dysfunction might serve as examples of normal TMJ's in the general population not seeking orthodontic care.
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Affiliation(s)
- Simona Tecco
- Department of Oral Science, Nano and Biotechnology, University G,D'Annunzio, Via dei Vestini 31, Chieti, 66013, Italy.
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Skeletal and dental asymmetries in Class II subdivision malocclusions using cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2010; 138:542.e1-20; discussion 542-3. [PMID: 21055586 DOI: 10.1016/j.ajodo.2010.02.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 02/01/2010] [Accepted: 02/01/2010] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The objective of this study was to compare the degrees of skeletal and dental asymmetry between subjects with Class II subdivision malocclusions and subjects with normal occlusions by using cone-beam computed tomography. METHODS Thirty subjects with Angle Class II subdivision malocclusions (mean age, 13.99 years) and 30 subjects with normal occlusions (mean age, 14.32 years) were assessed with 3-dimensional cone-beam computed tomography scans. Independent t tests were used to compare orthogonal, linear, and angular measurements between sides and between groups. RESULTS Total mandibular length and ramus height were shorter on the Class II side. Pogonion, menton, and the mandibular dental midline were deviated toward the Class II side. Gonion and the anterior condyle landmark were positioned more posteriorly on the Class II side. The mandibular dental landmarks were located more latero-postero-superiorly, and the maxillary dental landmarks more latero-antero-superiorly on the Class II side. There was loss of maxillary arch length, and the mandibular molar was closer to the ramus on the Class II side. CONCLUSIONS The etiology of Class II subdivision malocclusions is primarily due to an asymmetric mandible that is shorter and positioned posteriorly on the Class II side. A mesially positioned maxillary molar and a distally positioned mandibular molar on the Class II side are also minor contributing factors.
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Demant S, Hermann NV, Darvann TA, Zak M, Schatz H, Larsen P, Kreiborg S. 3D analysis of facial asymmetry in subjects with juvenile idiopathic arthritis. Rheumatology (Oxford) 2010; 50:586-92. [DOI: 10.1093/rheumatology/keq329] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ringold S, Cron RQ. The temporomandibular joint in juvenile idiopathic arthritis: frequently used and frequently arthritic. Pediatr Rheumatol Online J 2009; 7:11. [PMID: 19480670 PMCID: PMC2694194 DOI: 10.1186/1546-0096-7-11] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 05/29/2009] [Indexed: 11/10/2022] Open
Abstract
Recent recognition of the markedly high prevalence of temporomandibular joint (TMJ) arthritis in children with juvenile idiopathic arthritis (JIA) coupled with the significant morbidity associated with TMJ damage has prompted increased interest in both the clinical and pathological aspects of TMJ arthritis. This review focuses on the prevalence of TMJ arthritis in JIA, the imaging modalities used to detect TMJ arthritis, and the treatment of TMJ arthritis in children with JIA.
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Affiliation(s)
- Sarah Ringold
- Department of Pediatrics, Division of Rheumatology, Seattle Children's Hospital, Seattle WA, USA.
| | - Randy Q Cron
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham AL, USA
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