The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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The validity of transcranial radiography in diagnosis of internal derangement

악관절 내장증 평가 시 경두개 방사선사진의 임상적 유용성: MRI와의 비교연구

  • Lee, In-Song (Department of Orthodontics, School of Dentistry, Seoul National University) ;
  • Ahn, Sug-Joon (Department of Orthodontics, School of Dentistry, Seoul National University) ;
  • Kim, Tae-Woo (Department of Orthodontics, School of Dentistry, Seoul National University)
  • 이인송 (서울대학교 치과대학 교정학교실) ;
  • 안석준 (서울대학교 치과대학 교정학교실) ;
  • 김태우 (서울대학교 치과대학 교정학교실)
  • Published : 2006.04.30
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Abstract

The purpose of this study was to determine whether association exists between temporomandibular joint (TMJ) characteristics in transcranial radiographs and TMJ internal derangement and to evaluate the validity of transcranial radiographs in diagnosis of internal derangement. Transcranial radiographs and magnetic resonance imaging (MRI) of 113 TMJs from 76 subjects were used for this study and all TMJs were classified into 3 groups according to the results of MRI: normal disk position, disk displacement with reduction, and disk displacement without reduction. Transcranial analysis included linear measurement of joint spaces and condylar head angle measurement. To determine any relationship between transcranial measurements according to disk displacement, one-way ANOVA was used. The results showed that condyle-fossa relationship in standard transcranial radiographs had no relationships with disk displacement. And, as disk displacement progressed, condylar angle between head and neck increased significantly. This result can be interpreted that condylar head angle reflects structural hard tissue change according to internal derangement progress. But this is insufficient in the determination of internal derangement. Therefore, although still clinically helpful, the validity of standard transcranial radiographs to diagnose TMJ internal derangement was questioned.

본 연구는 표준 경두개 방사선사진에서 나타나는 하악두/관절와의 위치 관계 및 형태 특징과 MRI에서 관찰되는 관절원판의 변위 여부를 비교함으로써 측두하악관절 내장증 평가 시 경두개 방사선사진의 임상적 이용 가능성을 알아보고자 하였다. 연구는 성인 환자 76명(남자 26명, 여자 50명)의 113개 악관절을 대상으로 하였다 MRI 자료를 기초로 하여 각 악관절을 정상군, 정복성 관절원판 변위군, 비정복성 관절원판 변위군으로 분류하였으며 최대 감합시의 경두개 방사선사진에서 관절와와 하악두 간의 전방, 후방 및 상방 직선 거리를 계측하여 상대적 위치 평가를 하고 형태적 특징을 판별하기 위해 악관절 경부와 두부간의 각도를 계측하였다. 또한 각 군에 따라 경두개 방사선 계측항목 간에 유의성 있는 차이가 있는지 알아보기 위해 일원분산분석과 다중비교분석을 시행하였다. 표준 경두개 방사선사진에서 나타나는 관절와와 하악두의 위치 관계는 관절원판 변위 여부 및 진행 정도와 상관성을 보이지 않았다. 또한 하악측두관절 경부와 하악두가 이루는 각도는 비정복성 관절원판 변위군에서 유의성 있게 증가하였다. 이는 하악두각이 악관절 내장증의 진행에 따른 악관절의 구조적인 경조직 변화를 반영한다고 볼 수 있으나 이것에만 근거하여 관절원판 변위 여부를 판단하기에는 근거가 미약하다.

Keywords

References

  1. Wyatt WE. Preventing adverse effects on the temporomandibular joint through orthodontic treatment. Am J Orthod Dentofacial Orthop 1987;91:493-9 https://doi.org/10.1016/0889-5406(87)90006-0
  2. Paesani D, Westesson PL, Hatala M, Tallents RH, Kurita K. Prevalence of temporomandibular joint internal derangement in patients with craniomandibular disorders. Am J Orthod Dentofacial Orthop 1992;101:41-7 https://doi.org/10.1016/0889-5406(92)70080-T
  3. Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG, Omnell KA, et al. Imaging of the temporomandibular joint. A position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol 1997:83:609-18 https://doi.org/10.1016/S1079-2104(97)90128-1
  4. Katzberg RW, Schenck J, Roberts D, Tallents RH, Manzione JV, Hart HR, et al. Magnetic resonance imaging of the temporomandibular joint (TMJ) meniscus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1985;59:332-5 https://doi.org/10.1016/0030-4220(85)90052-0
  5. Van Sickels JE, Bianco HJ Jr, Pifer RG. Transcranial radiographs in the evaluation of craniomandibular disorders. J Prosthet Dent 1983;49:244-9 https://doi.org/10.1016/0022-3913(83)90510-3
  6. Gray RJ, Quayle AA, Horner K. The effects of positioning variations in transcranial radiographs of the temporomandibular joint: a laboratory study. Br J Oral Maxillofac Surg 1991:29:241-9 https://doi.org/10.1016/0266-4356(91)90191-7
  7. Knoernschild KL, Aquilino SA, Ruprecht A. Transcranial radiography and linear tomography: a comparative study. J Prosthet Dent 1991:66:239-50 https://doi.org/10.1016/S0022-3913(05)80055-1
  8. Dixon DC, Graham GS, Mayhew RB, Oesterle LJ, Simms D, Pierson WP. The validity of transcranial radiography in diagnosing TMJ anterior disk displacement. J Am Dent Assoc 1984:108:615-8 https://doi.org/10.14219/jada.archive.1984.0399
  9. Pullinger A, Hollender L. Assessment of mandibular condyle position: A comparison of transcranial radiographs and linear tomograms. Oral Surg Oral Med Oral Pathol 1985:60:329-34 https://doi.org/10.1016/0030-4220(85)90319-6
  10. Cohlmia JT, Ghosh J, Sinha PK, Nanda RS, Currier GF. Tomographic assessment of temporomandibular joints in patients with malocclusion. Angle Orthod 1996:66:27-35
  11. Dahlberg G. Statistical methods for medical and biological students. London: George Allen & Unwin Ltd: 1940. p. 122-32
  12. Pringle JH. Displacement of the mandibular meniscus and its treatment. Br J Surg 1918:6:385-9 https://doi.org/10.1002/bjs.1800062307
  13. Katzberg RW, Westesson PL. Diagnosis of temporomandibular joint. 1st ed. Philadelphia: Saunders: 1993
  14. Weinberg LA. Role of condylar position in TMJ dysfunction pain syndrome. J Prosthet Dent 1979:41:636-43 https://doi.org/10.1016/0022-3913(79)90062-3
  15. Brand JW, Whinery JG Jr, Anderson QN, Keenan KM. The effects of temporomandibular joint internal derangement and degenerative joint disease on tomographic and arthrotomographic images. Oral Surg Oral Med Oral Pathol 1989;67:220-3 https://doi.org/10.1016/0030-4220(89)90337-X
  16. Mikhail MG. The validity of temporomandibular joint radiographs using the head positioner. J Prosthet Dent 1979:42:441-6 https://doi.org/10.1016/0022-3913(79)90148-3
  17. Dawson PE. Evaluation, diagnosis and treatment of occlusal problems. 2nd ed. St Louis: Mosby; 1989. p. 608-16
  18. Ricketts RM. Variations of the TMJ as revealed by cephalometric laminagarphy, Am J Orthod 1950:36:877-98 https://doi.org/10.1016/0002-9416(50)90055-8
  19. Farrar WE. Differentiation of temporomandibular joint dysfunction to simplify treatment. J Prosthet Dent 1972;28:629-36 https://doi.org/10.1016/0022-3913(72)90113-8
  20. Ismail YH, Rokni A. Radiographic study of condylar position in centric relation and centric occlusion. A comparison study of information obtained with different radiorgaphic techniques. J Prosthet Dent 1980;43:327-30 https://doi.org/10.1016/0022-3913(80)90411-4
  21. Hansson LG, Petersson A. Radiography of the temporomandibular joint using the transpharyngeal projection. Dentomaxillofac Radiol 1978;7:69-78 https://doi.org/10.1259/dmfr.1978.0010
  22. Eckerdal O, Lundberg M. The structural situation in temporomandi bular joints. A comparison between conventional oblique transcranial radiographs, tomograms and histologic sections. Dentomaxillofac Radiol 1979;8:42-9 https://doi.org/10.1259/dmfr.1979.0004
  23. Klein IE, Blatterfein L, Miglino JC. Comparison of the fidelity of radiographs of mandibular condyles made by different techniques. J Ptosthet Dent 1970:24:419-52 https://doi.org/10.1016/0022-3913(70)90083-1
  24. Weinberg LA. What we really see in a TMJ radiograph. J Prosthet Dent 1973;30:898-913 https://doi.org/10.1016/0022-3913(73)90284-9
  25. Weinberg LA. An evaluation of asymmetry in TMJ radiographs. J Prosthet Dent 1978;40:315-23 https://doi.org/10.1016/0022-3913(78)90040-9
  26. Weinberg LA. The role of stress, occlusion, and condyle position in TMJ dysfunction-pain. J Prosthet Dent 1983:49:532-45 https://doi.org/10.1016/0022-3913(83)90318-9
  27. Gelb H, Gelb M. Taking the mystique out of the diagnosis and treatment of craniomandibular (TMJ) disorders. Int Dent J 1989;39:129 -39
  28. Laskin D, Greenfield W. The president's conference on the examination, diagnosis, and management of temporomandibular disorders. Chicago: The American Dental Association: 1982
  29. Blaschke DD, Blaschke TJ, Normal TMJ bony relationships in centric occlusion. J Dent Res 1981:60:98-104 https://doi.org/10.1177/00220345810600021901
  30. Ren YF, Isberg A, Westesson PL. Condyle position in the temporomandibular joint. comparison between asymptomatic volunteers with normal disk position and patients with disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:101-7 https://doi.org/10.1016/S1079-2104(95)80025-5
  31. Bonilla-Aragon H, Tallents RH, Katzberg RW, Kyrkanides S, Moss ME. Condyle position as a predictor of temporomandibular joint internal derangement. J Prosthet Dent 1999;82:205-8 https://doi.org/10.1016/S0022-3913(99)70157-5
  32. Ozawa S, Boering G, Kawata T, Tanimoto K, Tanne K. Reconsideration of the TMJ condylar position during internal derangement: Comparison between condylar position on tomogram and degree of disk displacement of MRI. Cranio 1999:17:93-100
  33. Major PW, Kinniburgh RD, Nebbe B, Prasad NG, Glover KE. Tomographic assessment of temporomandibular joint osseous articular surface contour and spatial relationships associated with disc displacement and disc length. Am J Orthod Dentofacial Orthop 2002;121:152-61 https://doi.org/10.1067/mod.2002.120641
  34. Westesson PL. Structural hard-tissue changes in temporomandibular joints with internal derangement. Oral Surg Oral Med Oral Pathol 1985:59:220-4 https://doi.org/10.1016/0030-4220(85)90022-2
  35. Rao VM, Babaria A, Manoharan A, Mandel S, Gottehrer N, Wank H, et al. Altered condylar morphology associated with disc displacement in TMJ dysfunction: observations by MRI. MagnReson Imaging 1990;8:231-5 https://doi.org/10.1016/0730-725X(90)90094-I
  36. Brooks SL, Westesson PL, Eriksson L, Hansson LG, Barsotti JB. Prevalence of osseous changes in the temporomandibular joint of asymptomatic persons without internal derangement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1992;73:122-6
  37. Kurita H, Ohtsuka A, Kobayashi H, Kurashina K. Relationship between increased horizontal condylar angle and resorption of the posterosuperior region of the lateral pole of the mandibular condyle in temporomandibular joint internal derangement. Dentomaxillofac Radiol 2003;32:26-9 https://doi.org/10.1259/dmfr/23245517