Aim: To describe cone-beam computed tomography (CBCT) features in patients with temporomandibular disorders (TMDs), in terms of degenerative changes, condylar excursions and positioning as well as their possible correlations with signs and symptoms. Methods: Clinical records of patients diagnosed with TMD who were seen between January 2018 and December 2019 were retrospectively evaluated. These patients were divided into the following groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): arthralgia, myalgia, and arthralgia and myalgia groups. The CBCT examination findings of the patients were evaluated in relation to degenerative changes, estimates of condylar excursion, and condylar positioning. The likelihood ratio test was used to verify the possible differences among the three groups, whereas the chi-square test was used to verify the possible differences among the signs and symptoms for the tomographic findings (p ≤ 0.050). Results: In this study, 65 patients with TMD were included. These patients were predominantly female (84.6%) with a mean age of 40.6 years. Tomographic findings of flattening, hyperexcursion and posterior condylar positioning were frequent. A significant correlation was noted between osteophyte and lateral capsule pain (p = 0.027), erosion and posterior capsule pain (p = 0.026), and flattening, pseudocysts (p < 0.050) and condylar excursion (p < 0.001) with mouth opening. Conclusion: Few correlations were noted between degenerative changes and signs of joint pain as well as degenerative changes and condylar hypoexcursion with mouth opening. These correlations were likely associated with division by diagnosis, whereas condylar positioning did not correlate with signs and symptoms.
Suenaga S, Nagayama K, Nagasawa T, Indo H, Majima HJ. The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders. Jpn Dent Sci Rev. 2016 Nov;52(4):93-106. doi: 10.1016/j.jdsr.2016.04.004.
Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Dent Clin North Am. 2013 Jul;57(3):405-18. doi: 10.1016/j.cden.2013.04.008.
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 Feb;37(2):63-71. doi: 10.1259/dmfr/16932758.
Larheim TA, Hol C, Ottersen MK, Mork-Knutsen BB, Arvidsson LZ. The role of imaging in the diagnosis of temporomandibular joint pathology. Oral Maxillofac Surg Clin North Am. 2018 Aug;30(3):239-49. doi: 10.1016/j.coms.2018.04.001.
Alkhader M, Kuribayashi A, Ohbayashi N, Nakamura S, Kurabayashi T. Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology. Dentomaxillofac Radiol. 2010 Sep;39(6):343-8. doi: 10.1259/dmfr/76385066.
Barghan S, Tetradis S, Mallya SM. Application of cone beam computed tomography for assessment of the temporomandibular joints. Austr Dent J. 2012 Mar;57 Suppl 1:109-18. doi: 10.1111/j.1834-7819.2011.01663.x.
Luz JG, Maragno IC, Martin MC. Characteristics of chief complaints of patients with temporomandibular disorders in a Brazilian population. J Oral Rehabil. 1997 Mar;24(3):240-3. doi:10.1111/j.1365-2842.1997.tb00320.x
de Carvalho EF, Chilvarquer I, Luz JGC. Correlations between tomographic findings related to degenerative changes, condylar excursions and position, and pain symptomatology in temporomandibular disorders. J Orofac Sci. 2018 Jan-Jun;10(1):7-13. doi: 10.4103/jofs.jofs_89_17.
Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014; 28(1):6-27. doi: 10.11607/jop.1151.
Hintze H, Wiese M, Wenzel A. Cone beam CT and conventional tomography for the detection of morphological temporomandibular joint changes. Dentomaxillofac Radiol. 2007 May;36(4):192-7. doi: 10.1259/dmfr/25523853.
Talaat W, Al Bayatti S, Al Kawas S. CBCT analysis of bony changes associated with temporomandibular disorders. Cranio. 2016 Mar;34(2):88-94. doi: 10.1179/2151090315Y.0000000002.
Bakke M, Petersson A, Wiesel M, Svanholt P, Sonnesen L. Bony deviations revealed by cone beam computed tomography of the temporomandibular joint in subjects without ongoing pain. J Oral Facial Pain Headache. 2014;28(4):331-7. doi: 10.11607/ofph.1255.
De Coster PJ, Van den Berghe LI, Martens LC. Generalized joint hypermobility and temporomandibular disorders: Inherited connective tissue disease as a model with maximum expression. J Orofac Pain. 2005;19(1):47-57.
Nosouhian S, Haghighat A, Mohammadi I, Shadmehr E, Davoudi A, Badrian H. Temporomandibular joint hypermobility manifestation based on clinical observations. J Int Oral Health. 2015 Aug;7(8):1-4.
Robinson de Senna B, Marques LS, França JP, Ramos-Jorge ML, Pereira LJ. Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Sep;108(3):e117-24. doi: 10.1016/j.tripleo.2009.04.034.
Sener S, Akgunlu F. Correlation between the condyle position and intra-extraarticular clinical findings of temporomandibular dysfunction. Eur J Dent. 2011 Jul;5(3):354-60.
Haghigaht A, Davoudi A, Rybalov O, Hatami A. Condylar distances in hypermobile temporomandibular joints of patients with excessive mouth openings by using computed tomography. J Clin Exp Dent. 2014;6(5):e509-13. doi: 10.4317/jced.51562.
Kinniburgh RD, Major PW, Nebble B, West K, Glover KE. Osseous morphology and spatial relationships of the temporomandibular joint: comparisons of normal and anterior disc positions. Angle Orthod. 2000 Feb;70(1):70-80. doi: 10.1043/0003-3219(2000)070<0070:OMASRO>2.0.CO;2.
Ikeda K, Kawamura A. Assessment of optimal condylar position with limited cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2009 Apr;135(4):495-501. doi: 10.1016/j.ajodo.2007.05.021.
Paknahad M, Shahidi S, Iranpour S, Mirhadi S, Paknahad M. Cone-beam computed tomographic assessment of mandibular condylar position in patients with temporomandibular joint dysfunction and in healthy subjects. Int J Dent. 2015;2015:301796. doi: 10.1155/2015/301796.
Imanimoghaddam M, Madani AS, Mahdavi P, Bagherpour A, Darijani M, Ebrahimnejad H. Evaluation of condylar positions in patients with temporomandibular disorders: A cone-beam computed tomographic study. Imaging Sci Dent. 2016 Jun;46(2):127-31. doi: 10.5624/isd.2016.46.2.127.
Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol. 2009 Mar;38(3):141-7. doi: 10.1259/dmfr/59263880.
Koç N. Evaluation of osteoarthritic changes in the temporomandibular joint and their correlations with age: A retrospective CBCT study. Dent Med Probl. 2020 Jan-Mar;57(1):67-72. doi: 10.17219/dmp/112392.
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 Dec;36(8):472-7. doi: 10.1259/dmfr/28078357.
Nah KS. Condylar bony changes in patients with temporomandibular disorders: a CBCT study. Imaging Sci Dent. 2012 Dec;42(4):249-53. doi: 10.5624/isd.2012.42.4.249.
Cömert Kiliç S, Kiliç N, Sümbüllü MA. Temporomandibular joint osteoarthritis: Cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg. 2015 Oct;44(10):1268-74. doi: 10.1016/j.ijom.2015.06.023.
Al-Ekrish AA, Al-Juhani HO, Alhaidari RI, Alfaleh WM. Comparative study of the prevalence of temporomandibular joint osteoarthritic changes in cone beam computed tomograms of patients with or without temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Jul;120(1):78-85. doi: 10.1016/j.oooo.2015.04.008.
Dias IM, Coelho PR, Assis NM, Leite FP, Devito KL. Evaluation of the correlation between disc displacements and degenerative bone changes of the temporomandibular joint by means of magnetic resonance images. Int J Oral Maxillofac Surg. 2012 Sep;41(9):1051-7. doi: 10.1016/j.ijom.2012.03.005.
Abdel-Alim HM, Abdel-Salam Z, Ouda S, Jadu FM, Jan AM. Validity of cone-beam computed tomography in assessment of morphological bony changes of temporomandibular joints. J Contemp Dent Pract. 2020 Feb 1;21(2):133-9. doi: 10.5005/jp-journals-10024-2732.
Ulay G, Pekiner FN, Orhan K. Evaluation of the relationship between the degenerative changes and bone quality of mandibular condyle and articular eminence in temporomandibular disorders by cone beam computed tomography. Cranio. 2020 Dec 3;1-12. doi: 10.1080/08869634.2020.1853307.
Yasa Y, Akgül HM. Comparative cone-beam computed tomography evaluation of the osseous morphology of the temporomandibular joint in temporomandibular dysfunction patients and asymptomatic individuals. Oral Radiol 2018 Jan;34(1):31-9. doi: 10.1007/s11282-017-0279-7.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2021 Brazilian Journal of Oral Sciences