Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
권호 표지
DOI QR코드

DOI QR Code

Internal derangement as a predictor of provoked pain on mouth opening: A magnetic resonance imaging study

  • Koh, Kwang-Joon (Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University) ;
  • Park, Ha-Na (Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University) ;
  • Kim, Kyoung-A (Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University)
  • Received : 2017.08.14
  • Accepted : 2017.09.23
  • Published : 2017.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study investigated the relationship between pain and internal derangement in temporomandibular disorder(TMD) patients using magnetic resonance imaging (MRI). Materials and Methods: This study analyzed 356 TMD patients (712 temporomandibular joints [TMJs]). The inclusion criteria were the presence of spontaneous or provoked pain on one or both TMJs and having undergone MRI. The patients with provoked pain were divided into 3 groups: pain on palpation, pain on mouth opening, and pain on mastication. MRI was performed using a 1.5-T scanner. T1- and T2-weighted parasagittal and paracoronal images were obtained. According to the findings on the T1-weighted images, another 3 groups were created based on internal derangement: normal, disc displacement with reduction, and disc displacement without reduction. The MRI findings were independently interpreted by 2 experienced oral and maxillofacial radiologists at 2 different times. Statistical analysis was performed by the chi-square test using SPSS (version 12.0; SPSS Inc., Chicago, IL, USA). Results: Provoked pain on mouth opening was found to be correlated with internal derangement in TMD patients (P<.05). However, spontaneous pain and provoked pain on palpation or mastication were not associated with internal derangement(P>.05). Conclusion: These results suggest that internal derangement was a significant predictor of provoked pain on mouth opening.

Keywords

References

  1. Drace JE, Enzmann DR. Defining the normal temporomandibular joint: closed-, partially open-, and open-mouth MR imaging of asymptomatic subjects. Radiology 1990; 177: 67-71. https://doi.org/10.1148/radiology.177.1.2399340
  2. Tasaki MM, Westesson PL. Temporomandibular joint: diagnostic accuracy with sagittal and coronal MR imaging. Radiology 1993; 186: 723-9. https://doi.org/10.1148/radiology.186.3.8430181
  3. Katzberg RW, Westesson PL, Tallents RH, Drake CM. Anatomic disorders of the temporomandibular joint disc in asymptomatic subjects. J Oral Maxillofac Surg 1996; 54: 147-53. https://doi.org/10.1016/S0278-2391(96)90435-8
  4. Larheim TA. Role of magnetic resonance imaging in the clinical diagnosis of the temporomandibular joint. Cells Tissues Organs 2005; 180: 6-21. https://doi.org/10.1159/000086194
  5. 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; 52: 93-106. https://doi.org/10.1016/j.jdsr.2016.04.004
  6. Koh KJ, List T, Petersson A, Rohlin M. Relationship between clinical and magnetic resonance imaging diagnoses and findings in degenerative and inflammatory temporomandibular joint diseases: a systemic literature review. J Orofac Pain 2009; 23: 123-39.
  7. Tasaki MM, Westesson PL, Isberg AM, Ren YF, Tallents RH. Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers. Am J Orthod Dentofacial Orthop 1996; 109: 249-62. https://doi.org/10.1016/S0889-5406(96)70148-8
  8. Styles C, Whyte A. MRI in the assessment of internal derangement and pain within the temporomandibular joint: a pictorial essay. Br J Oral Maxillofac Surg 2002; 40: 220-8. https://doi.org/10.1054/bjom.2001.0757
  9. Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study. J Oral Rehabil 2003; 30: 537-43. https://doi.org/10.1046/j.1365-2842.2003.01111.x
  10. Heffez LB, Jordan SL. Superficial vascularity of temporomandibular joint retrodiskal tissue: an element of the internal derangement process. Cranio 1992; 10: 180-91. https://doi.org/10.1080/08869634.1992.11677909
  11. Taskaya-Yilmaz N, Ogutcen-Toller M. Magnetic resonance imaging evaluation of temporomandibular joint disc deformities in relation to type of disc displacement. J Oral Maxillofac Surg 2001; 59: 860-5. https://doi.org/10.1053/joms.2001.25015
  12. Eberhard L, Giannakopoulos NN, Rohde S, Schmitter M. Temporomandibular joint (TMJ) disc position in patients with TMJ pain assessed by coronal MRI. Dentomaxillofac Radiol 2013; 42: 20120199. https://doi.org/10.1259/dmfr.20120199
  13. Taskaya-Yylmaz N, Ogutcen-Toller M. Clinical correlation of MRI findings of internal derangements of the temporomandibular joints. Br J Oral Maxillofac Surg 2002; 40: 317-21. https://doi.org/10.1016/S0266-4356(02)00140-7
  14. Westesson PL, Eriksson L, Kurita K. Reliability of a negative clinical temporomandibular joint examination: prevalence of disk displacement in asymptomatic temporomandibular joints. Oral Surg Oral Med Oral Pathol 1989; 68: 551-4. https://doi.org/10.1016/0030-4220(89)90236-3
  15. Ribeiro RF, Tallents RH, Katzberg RW, Murphy WC, Moss ME, Magalhaes AC, et al. The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years. J Orofac Pain 1997; 11: 37-47.
  16. Usumez S, Oz F, Guray E. Comparison of clinical and magnetic resonance imaging diagnoses in patients with TMD history. J Oral Rehabil 2004; 31: 52-6. https://doi.org/10.1111/j.1365-2842.2004.01065.x
  17. Barclay P, Hollender LG, Maravilla KR, Truelove EL. Comparison of clinical and magnetic resonance imaging diagnosis in patients with disk displacement in the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88: 37-43. https://doi.org/10.1016/S1079-2104(99)70191-5
  18. Emshoff R, Rudisch A. Validity of clinical diagnostic criteria for temporomandibular disorders: clinical versus magnetic resonance imaging diagnosis of temporomandibular joint internal derangement and osteoarthrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91: 50-5. https://doi.org/10.1067/moe.2001.111129
  19. Huddleston Slater JJ, Lobbezoo F, Chen YJ, Naeije M. A comparative study between clinical and instrumental methods for the recognition of internal derangements with a clicking sound on condylar movement. J Orofac Pain 2004; 18: 138-47.
  20. Limchaichana N, Nilsson H, Ekberg EC, Nilner M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil 2007; 34: 237-45. https://doi.org/10.1111/j.1365-2842.2006.01719.x
  21. Matsuda S, Yoshimura Y, Lin Y. Magnetic resonance imaging assessment of the temporomandibular joint in disk displacement. Int J Oral Maxillofac Surg 1994; 23: 266-70. https://doi.org/10.1016/S0901-5027(05)80105-5
  22. Miller TL, Katzberg RW, Tallents RH, Bessette RW, Hayakawa K. Temporomandibular joint clicking with nonreducing anterior displacement of the meniscus. Radiology 1985; 154:121-4. https://doi.org/10.1148/radiology.154.1.3964930
  23. Okeson JP. Management of temporomandibular disorders and occlusion. 7th ed. St. Louis, MO: Elsevier/Mosby; 2013. p.1-20.
  24. Campos PS, Macedo Sobrinho JB, Crusoe-Rebello IM, Pena N, Dantas JA, Mariz AC, et al. Temporomandibular joint disc adhesion without mouth-opening limitation. J Oral Maxillofac Surg 2008; 66: 551-4. https://doi.org/10.1016/j.joms.2006.11.006
  25. Milano V, Desiate A, Bellino R, Garofalo T. Magnetic resonance imaging of temporomandibular disorders: classification, prevalence and interpretation of disc displacement and deformation. Dentomaxillofac Radiol 2000; 29: 352-61. https://doi.org/10.1038/sj.dmfr.4600555
  26. Emshoff R, Brandimaier I, Bertram S, Rudisch A. Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain. Int J Oral Maxillofac Surg 2002; 31: 598-602. https://doi.org/10.1054/ijom.2002.0314
  27. Murakami K, Nishida M, Bessho K, Iizuka T, Tsuda Y, Konishi J. MRI evidence of high signal intensity and temporomandibular arthralgia and relating pain. Does the high signal correlate to the pain? Br J Oral Maxillofac Surg 1996; 34: 220-4. https://doi.org/10.1016/S0266-4356(96)90273-9
  28. Park JW, Song HH, Roh HS, Kim YK, Lee JY. Correlation between clinical diagnosis based on RDC/TMD and MRI findings of TMJ internal derangement. Int J Oral Maxillofac Surg 2012; 41: 103-8. https://doi.org/10.1016/j.ijom.2011.09.010
  29. Westesson PL, Brooks SL. Temporomandibular joint: relationship between MR evidence of effusion and the presence of pain and disk displacement. AJR Am J Roentgenol 1992; 159: 559-63. https://doi.org/10.2214/ajr.159.3.1503025
  30. Orsini MG, Kuboki T, Terada S, Matsuka Y, Yatani H, Yamashita A. Clinical predictability of temporomandibular joint disc displacement. J Dent Res 1999; 78: 650-60. https://doi.org/10.1177/00220345990780020401
  31. Bertram S, Rudisch A, Innerhofer K, Pumpel E, Grubwieser G, Emshoff R. Diagnosing TMJ internal derangement and osteoarthritis with magnetic resonance imaging. J Am Dent Assoc 2001; 132: 753-61. https://doi.org/10.14219/jada.archive.2001.0272
  32. Rudisch A, Innerhofer K, Bertram S, Emshoff R. Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92: 566-71. https://doi.org/10.1067/moe.2001.116817
  33. Roh HS, Kim W, Kim YK, Lee JY. Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings. J Craniomaxillofac Surg 2012; 40: 283-6. https://doi.org/10.1016/j.jcms.2011.04.006
  34. Katzberg RW, Tallents RH. Normal and abnormal temporomandibular joint disc and posterior attachment as depicted by magnetic resonance imaging in symptomatic and asymptomatic subjects. J Oral Maxillofac Surg 2005; 63: 1155-61. https://doi.org/10.1016/j.joms.2005.04.012
  35. Sano T, Yamamoto M, Okano T, Gokan T, Westesson PL. Common abnormalities in temporomandibular joint imaging. Curr Probl Diagn Radiol 2004; 33: 16-24. https://doi.org/10.1016/j.cpradiol.2003.09.001
  36. Ohlmann B, Rammelsberg P, Henschel V, Kress B, Gabbert O, Schmitter M. Prediction of TMJ arthralgia according to clinical diagnosis and MRI findings. Int J Prosthodont 2006; 19: 333-8.
  37. Haley DP, Schiffman EL, Lindgren BR, Anderson Q, Andreasen K. The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. J Am Dent Assoc 2001; 132: 476-81. https://doi.org/10.14219/jada.archive.2001.0210
  38. Lopes SL, Costa AL, Cruz AD, Li LM de Almeida SM. Clinical and MRI investigation of temporomandibular joint in major depressed patients. Dentomaxillofac Radiol 2012; 41: 316-22. https://doi.org/10.1259/dmfr/27328352
  39. Vieira-Queiroz I, Gomes Torres MG, de Oliveira-Santos C, Flores Campos PS, Crusoe-Rebello IM. Biometric parameters of the temporomandibular joint and association with disc displacement and pain: a magnetic resonance imaging study. Int J Oral Maxillofac Surg 2013; 42: 765-70. https://doi.org/10.1016/j.ijom.2013.01.004
  40. Cholitgul W, Nishiyama H, Sasai T, Uchiyama Y, Fuchihata H, Rohlin M. Clinical and magnetic resonance imaging findings in temporomandibular joint disc displacement. Dentomaxillofac Radiol 1997; 26: 183-8. https://doi.org/10.1038/sj.dmfr.4600239
  41. Chowdary UV, Rajesh P, Neelakandan RS, Nandagopal CM. Correlation of clinical and MRI findings of temporo-mandibular joint internal derangement. Indian J Dent Res 2006; 17: 22-6. https://doi.org/10.4103/0970-9290.29896
  42. Lin WC, Lo CP, Chiang IC, Hsu CC, Hsu WL, Liu DW, et al. The use of pseudo-dynamic magnetic resonance imaging for evaluating the relationship between temporomandibular joint anterior disc displacement and joint pain. Int J Oral Maxillofac Surg 2012; 41: 1501-4. https://doi.org/10.1016/j.ijom.2012.05.023
  43. Suenaga S, Abeyama K, Hamasaki A, Mimura T, Noikura T. Temporomandibular disorders: relationship between joint pain and effusion and nitric oxide concentration in the joint fluid. Dentomaxillofac Radiol 2001; 30: 214-8. https://doi.org/10.1038/sj.dmfr.4600610
  44. Larheim TA, Westesson PL, Sano T. MR grading of temporomandibular joint fluid: association with disk displacement categories, condyle marrow abnormalities and pain. Int J Oral Maxillofac Surg 2001; 30: 104-12. https://doi.org/10.1054/ijom.2000.0017
  45. Kumar R, Pallagatti S, Sheikh S, Mittal A, Gupta D, Gupta S. Correlation between clinical findings of temporomandibular disorders and MRI characteristics of disc displacement. Open Dent J 2015; 9: 273-81. https://doi.org/10.2174/1874210601509010273
  46. Emshoff R, Brandlmaier I, Bosch R, Gerhard S. Rudisch A, Bertram S. Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup -disc derangement with reduction. J Oral Rehabil 2002; 29: 1139-45. https://doi.org/10.1046/j.1365-2842.2002.00980.x
  47. Marguelles-Bonnet RE, Carpentier P, Yung JP, Defrennes D, Pharaboz C. Clinical diagnosis compared with findings of magnetic resonance imaging in 242 patients with internal derangement of the TMJ. J Orofac Pain 1995; 9: 244-53.
  48. Takahara N, Nakagawa S, Sumikura K, Kabasawa Y, Sakamoto I, Harada H. Association of temporomandibular joint pain according to magnetic resonance imaging findings in temporomandibular disorder patients. J Oral Maxillofac Surg 2017; 75: 1848-55. https://doi.org/10.1016/j.joms.2017.03.026
  49. Adame CG, Monje F, Offnoz M, Martin-Granizo R. Effusion in magnetic resonance imaging of the temporomandibular joint: a study of 123 joints. J Oral Maxillofac Surg 1998; 56: 314-8. https://doi.org/10.1016/S0278-2391(98)90106-9
  50. Guler N, Yatmaz PI, Ataoglu H, Emlik D, Uckan S. Temporomandibular internal derangement: correlation of MRI findings with clinical symptoms of pain and joint sounds in patients with bruxing behaviour. Dentomaxillofac Radiol 2003; 32: 304-10. https://doi.org/10.1259/dmfr/24534480
  51. Dworkin SF, LeResche L, DeRouen T, Von Korff M. Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners. J Prosthet Dent 1990; 63: 547-9.
  52. Shaefer JR, Jackson DL, Schiffman EL, Anderson QN. Pressure-pain thresholds and MRI effusions in TMJ arthralgia. J Dent Res 2001; 80: 1935-9. https://doi.org/10.1177/00220345010800101401
  53. Ohrbach R, Gale EN. Pressure pain thresholds in normal muscles: reliability, measurement effects, and topographic differences. Pain 1989; 37: 257-63. https://doi.org/10.1016/0304-3959(89)90189-9
  54. Svensson P, Arendt-Nielsen L, Nielsen H, Larsen JK. Effect of chronic and experimental jaw muscle pain on pain-pressure thresholds and stimulus-response curves. J Orofac Pain 1995; 9: 347-56.
  55. Sano T, Westesson PL. Magnetic resonance imaging of the temporomandibular joint. Increased T2 signal in the retrodiskal tissue of painful joints. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79: 511-6. https://doi.org/10.1016/S1079-2104(05)80138-6
  56. McQuay HJ, Moore RA. An evidence-based resource for pain relief. Oxford: Oxford University Press; 1998. p. 14-31.
  57. Rammelsberg P, Pospiech PR, Jager L, Pho Duc JM, Bohm AO, Gernet W. Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83: 393-9. https://doi.org/10.1016/S1079-2104(97)90248-1

Cited by

  1. Somatosensory and psychosocial profile of patients with painful temporomandibular joint clicking vol.47, pp.11, 2017, https://doi.org/10.1111/joor.13081
  2. Analysis of related factors to internal derangement in temporomandibular joint dysfunction patients using magnetic resonance imaging vol.9, pp.2, 2017, https://doi.org/10.4103/jomr.jomr_11_21
  3. Diagnostic correlation between clinical protocols and magnetic resonance findings in temporomandibular disorders: A systematic review and meta‐analysis vol.48, pp.8, 2021, https://doi.org/10.1111/joor.13179