• Journal of Oral Medicine and Pain
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• v.31 no.3
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• pp.231-236
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• 2006

Rheumatoid arthritis(RA) is an of autoimmune inflammatory systemic disease. It is characterized by uncontrolled proliferation of synovial tissue and a wide array multisystem comorbidities. The disease may involve any joint of the body, but often statrs in the peripheral joints. It was reported that more than 50% of RA patients exhibit clinical involvement of TMJ. This report is a case report of dental management and progression for 16 months in patients who had severe bony change in TMJ involved rheumatoid arthritis Dental management was included palliative treatment such as interocclusal splints, physical therapy, mouth opening exercise. Although it was progressed rapidly osteolytic bone change during follow-up, no more advanced occulsal change and improved symptom and jaw motion. Further investigations about rule of dentistry in TMJ involvement in RA maybe needed.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.24 no.2
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• pp.217-225
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• 1994

저자는 측두하악장애 환자의 파노라마 방사선사진 상에서 이 장애와 관련된 변화를 조사하여 측두하악관절 장애의 진단과 치료에 도움을 주고자 하였다. 측두하악장애 환자의 364관절과 정상인 160관절부위를 대상으로 antegonial notch의 깊이, 과두돌기와 하악골상행지의 후방변위정도, 과두돌기, coronoid process 와 sigmoid notch의 길이를 측정하였다. 결과를 보면, 측두하악장애에 이환 된 경우 정상인에 비하여 통계적으로 유의하게 짧은 과두돌기와 하악지, 과두돌기에 비하여 상대적으로 긴 coronoid process, 그리고 깊은 antegonial notch와 오목한 하악골 상행지의 후연을 보였다.

• Journal of Oral Medicine and Pain
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• v.38 no.3
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• pp.267-274
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• 2013

This study was performed to investigate the skeletal factors related to open lock of the temporomandibular joint(TMJ). We compared the skeletal measurements on the cephalogram and transcranial radiograph among 3 groups, open lock group consisting of consecutively filed 50 patients with at least one open lock episode within recent 1 year, temporomandibular disorder(TMD) group of 50 TMD patients without open lock diagnosed by Research Diagnostic Criteria for TMD (RDC/TMD) Axis I, and normal group of 50 patients without TMD or open lock. The patients of TMD and normal group were randomly selected in an age-and-gender-matched way with ones of open lock group. Open lock group showed smaller saddle angle than normal group on cephalograms and steeper inclination of the articular eminence than TMD and normal groups on transcranial radiographs. These results imply that the patients with the joint located more anterior and the articular eminence with steeper inclination might be riskier to TMJ open lock.

• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.511-517
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• 1995

Bone scan is a very sensitive diagnostic imaging test for detecting bone and joint disorders. So it might be useful in the diagnosis of temporomandibular disorders of the joint origin. Thus, the effectiveness of bone scan for detecting temporomandibular joint(TMJ) diseases and differentiating the TMJ disc displacement from the TMJ arthritis was evaluated. Bone scan was done in 21 patients with TMJ disc displacement(13 unilaterally affected, 8 bilaterally affected), 25 patients with TMJ arthritis(23 unilateral, 3 bilateral), and 39 volunteers with no signs, symtoms, or history of TMJ disease. TMJ simple uptake rate(SUR) and difference of both TMJ SUR were calculated from the 100,000 count lateral image of head and neck region in 99mTc MDP bone scan. Transcranial and panorama X-ray examination was also done in all patients. TMJ SUR(%) were $1.673{\pm}0.606$ in TMJs affected with arthritis, $1350{\pm}0.351$ in TMJs affected with disc displacement, and $1.084{\pm}0.172$ in TMJs of controls. Significant differences were demonstrated among them(p<0.01) Difference of bith TMJ SUR was highest in patients with unilateral TMJ arthritis($0.608{\pm}$0.533, p<001), and there is no significant difference between that of controls and that of unilateral TMJ dist displacement patients($0.062{\pm}0.063$ vs $0.122{\pm}0.100$). TMJ SUR of Joint with bone change on X-ray finding was not significantly different from that of joint with normal X-ray finding. Those in patients with unilateral TMJ disc displacement(696% and 87% vs 23.1% and 23%). The proportions of patients with increased TMJ SUR and difference of both TMJ SUR(>mean+2SD of controls) in unilateral TMJ arthritis patients were significantly higher than those in patients with unilateral TMJ disc displacement(69.6% and 87% vs 23.1% and 23%). Conclusively, bone scan nay help to detect TMJ disease and differentiate TMJ disc displacement from TMJ arthritis.

• Journal of Oral Medicine and Pain
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• v.33 no.2
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• pp.195-204
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• 2008

Osteoarthritis is caused by joint degeneration, a process that includes progressive loss of articular cartilage accompanied by attempted repair of articular cartilage, remodeling and sclerosis of subchondral bone, and osteophyte formation. The most common causative factor that either causes or contributes to osteoarthritis is overloading of the articular structures of the joint. The diagnosis of temporomandibular joint(TMJ) osteoarthritis is based on the patient's history and clinical findings such as limited mandibular opening, crepitation and tenderness to palpation on TMJ. The diagnosis is usually confirmed by TMJ radiographs, which will reveal evidence of structural changes in the subarticular bone of the condyle or fossa. Plain radiography techniques such as panoramic, transcranial, transpharyngeal views can be used in most dental offices for evaluation of the TMJs. However, plain radiographs are often limited due to overlapping and distortion of anatomical structures. The aim of this study was to compare the clinical examination and panoramic view with computed tomography for diagnosis of temporomandibular degenerative joint disease, and to compare the findings of condylar bony changes through panoramic radiography with that of computed tomography, hence, to confirm the limitations of clinical and panoramic radiography, and the validity of the computed tomography for diagnosis of temporomandibular degenerative joint disease. The pathophysiology of the TMJ osteoarthritis remains poorly understood, and current treatments are based more on speculation than science, and symptomatic treatments often fail to provide satisfactory pain relief. For diagnosis of TMJ osteoarthritis, clinical examination and radiographic examination for confirmation of the bony changes are essential, and computed tomography are clearly superior to plain radiographs for their limitations.

• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.53-63
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• 2011

Osteoarthritis (OA), the most common form of arthritis, is a result of both mechanical and biological events that destabilize the normal coupling of degradation and synthesis of articular cartilage chondrocytes and extracelluar matrix, and subchondral bone. Although it is likely that the molecular basis of pathogenesis is similar to that of other joints, additional study of the temporomandibular joint (TMJ) is required due to its unique structure and function. This study was carried out to evaluate the epidemiologic characteristics of TMJ osteoarthritis. The purpose of this study was to investigate the prevalence of TMJ OA in Patients with temporomandibular disorders (1405 men and 2922 women whose mean age was $30.2\; {\pm}\; 15.4$ and $33.1\;{\pm}\;15.2$ years, respectively) who had visited the TMJ and Orofacial Pain Clinic of Seoul National University Dental Hospital in 2007. Orthopantomograms, TMJ tomograms and transcranial radiographs were used to evaluate degenerative change of the mandibular condyle. The obtained results were as follows: 1. Degenerative change of the mandibular condyle was observed in 883 (20.4%) of 4327 subjects. The prevalence was significantly higher in women (706 patients, 24.1%) than in men (177 patients, 12.6%), and this significant difference between genders was observed in all age groups. 2. The prevalence of degenerative change of the mandibular condyle in TMD patients showed a gentle increase along with age. Such increase was statistically significant in women (P < 0.001), but not in men. 3. Sclerosis was observed the most frequently in all age groups and the mean age of the patients with osteophyte was the highest among four types of degenerative change. 4. Although men showed degenerative change in the left side more often and women showed degenerative change more frequently in both sides, the difference of distribution in sides between genders was not significant. In conclusion, the prevalence of degenerative change of the mandibular condyle in TMD patients is higher in women than in men, and increases steadily with aging, but not as dramatically as in other joints that show a steep increase in prevalence around the age of 45 years. It can be suggested that the epidemiologic characteristic of OA of the TMJ differs from those of other joints, and that a more extensive study based on the general population is necessary.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.2
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• pp.130-134
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• 1997

The sagittal split ramus osteotomy(SSRO) of the mandible has used one of the most popula methods for the correction of various dentofacial deformities, especially mandibular prognathism. In SSRO, there are produced bony gap following mandible setback because of mandibular flaring. For this reason, the condylar axis may be changed due to bony approximation both segment in three dimension more mesio-laterally. According to change of condylar position, the condition of TMJ structure are changed and change of TMJ symptoms are suggested theoretically, and the correction of malocclusion by SSRO may improve the TMJ symptoms by improvement of feeding difficulties. The pupose of this study was to determine relationship between expected alterations in condylar position and suggested TMJ symptoms produced by change of condylar position. TMJ symptoms of 15patients who had operated SSRO are checked at about postoperative 6 month ranging $5{\sim}11$ month. Anterior-posterior position of condyle which was comparison preoperative with postoperative position, was classified 5 groups. The author tried to identify relationship between positional change of condyle and TMJ discomfort.

• Journal of Oral Medicine and Pain
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• v.31 no.3
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• pp.237-243
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• 2006

The aims of this study was to investigate the clinical and radiographic features of temporomandibular dysfunction in the patients with RA to elucidate whether the RA patients would be a risk group for TMD. The 35 patients with temporomandibular joint dysfunction were included for this study, of which 15 had rheumatoid arthritis diagnosed by a rheumatologist, and other 20 was control group and they didn't have any history or clinical signs related to it. Clinical symptoms and signs of temporomandibular joint disorders, radiographic and MRI findings of temporomandibular joint were investigated. The results were compared between two groups. In RA group bilateral pain, morning stiffness, reduced opening range, and crepitations were more frequently reported than control group. Radiologic findings such as sclerosis and flattening of condylar head, marginal proliferation, and erosion of glenoid fossa were more frequently observed in RA group than control group. Disk destruction, cortical bone erosion, and intraarticular enhancement were more prominenet in RA group. From theses results, it can be concluded that many RA patients will develop TMD symptoms and the structural changes of TMJ is more extensive than the usual TMD cases.

• Journal of Dental Rehabilitation and Applied Science
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• v.28 no.3
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• pp.291-299
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• 2012

There are many kinds of techniques for imaging temporomandibular joints. None of them for imaging "best fit" for every patient of temporomandibular disorder is recommended ideally. It is more important to be able to select the modality that is most adequate and appropriate for a given clinical issue.

• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.87-95
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• 2013

Osteoarthritis (OA) of the temporomandibular joint (TMJ) is a severe form of temporomandibular disorders (TMDs), presenting gradual breakdown of articular cartilage and subchondral bone by the functional load sustained to exceed the physiologic tolerance of the joint. In such a joint loaded, offensive bioactive materials such as matrix degrading proteins, cytokines, and free radicals increase in concentration to shift the tissue response in the joint to degeneration from regeneration or remodeling. Recently, it has been issued that obesity can play an offensive role in pathogenesis of OA in a metabolic way. Adipokines released by adipose cells are present at higher concentration in the arthritic joint and joints of obese individuals. However, because of conflicting data reported, further scientific study should be performed to elucidate the practical role of adipokines in pathogenesis of TMJ OA. As far as the clinical signs and symptoms of TMJ OA are not much different from those of other forms of TMD and any definitive treatment modality to control directly the bone resorptive activity is not available yet, the treatment of TMJ OA should be directed to reduce the physical load and enhance the physiologic tolerance of the joint by means of conservative treatment such as physical therapy, medication, and occlusal splint therapy for sufficient period and, if needed after that, supplementary surgical procedure such as intra-articular injection, arthrocenthesis, and arthroscopic surgery that have turned out to be effective to control OA signs and symtpoms. Enthusiastic reassurance and motivation for patients to control behaviors for themselves to reduce unnecessary functional load in daily life is very important for the joint to reach to more favorable orthopedic stability of the TMJ more quickly, guaranteeing more successful management TMJ OA.