• Journal of Oral Medicine and Pain
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• v.25 no.1
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• pp.73-85
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• 2000

The purposes of the study were (1) to see if there are various types of disc configuration in normal temporomandibular joint and, if so, (2) to examine whether a specific type of disc configuration is susceptible to disc displacement, and (3) to see if a specific type of disc configuration and position is related to early relief of clinical symptoms from the anterior disc displacement without reduction to conservative treatment. From the magnetic resonance (MR) images taken for the patients with symptoms of temporomandibular disorders, 235 images as normal joint group, 255 images as anterior disc displacement with reduction group, and 249 images as anterior disc displacement without reduction group were selected, After the TMJ image was scanned and processed with Photoshop program, the disc configuration was determined, The incidence of various types of disc configuration was analyzed according to age, sex, diagnostic group, and the promptness of symptom relief. The disc position was also examined in relation to the promptness of symptom relief. The results were as follows : 1. In the normal joint group, biconcave type appeared most frequently and reversed, biplanar type in order, Posterior band enlarged and folded type didn't appear at all. On the other hand, in the anterior disc displacement without reduction group, folded type appeared most frequently and also posterior band enlarged type were found often. 2. There were statistically significant differences between sex and configuration of disc in the normal joint group and no statistically significant differences in the anterior disc displacement with reduction group and anterior disc displacement without reduction group, 3. There were no statistically significant differences between age and configuration of disc in the normal, anterior disc displacement with reduction group and anterior disc displacement without reduction group. 4. In anterior disc displacement without reduction group, rapid response was observed in biconcave and reversed type and delayed response was observed in folded type.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.28 no.1
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• pp.155-169
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• 1998

The purpose of this study was to prove the relationship between arthrographic and clinical features in temporomandibular joint disorders. In order to carry out this study, ninety-eight arthrographic examinations of temporomandibular joints were performed on eighty-two patients who had the temporomandibular joint disorders. As the arthrographic examination, the cases were classified in three groups, disk displacement with reduction, disk displacement without reduction, within normal limit. After this, the cases were clinically examined, and the results were compared and analyzed in each other group. The obtained results were as follows; 1. As the classification by arthrographic examination, three groups (disc displacement with reduction, disc displacement without reduction, within normal limit) were 41 ％, 54％, 5％ of total cases in this study, respectively. 2. The third decade(65％) was most frequent in this study. The average age of each group (disc displacement with reduction, disc displacement without reduction, within normal limit) was 24, 28, 21, and disc displacement without reduction group was higher than any other group. 3. In the chief complaint, pain was the most frequent in all three groups. Joint sound was also frequent in disc displacement with reduction group, but in disc displacement without reduction group, limitation of mouth opening was more frequent. 4. Of the various pain, the movement pain was most frequent ( 61 ％) in this study. In joint sound, click(63％) was the most frequent in disc displacement with reduction group, but sound history(42％) and no sound (31 ％) were more frequent in disc displacement without reduction group. 5. The average maximum opening of each group (disc displacement with reduction, disc displacement without reduction, within normal limit) was 44mm, 32.9mm, 44mm, and disc displacement without reduction group was less than any other group. 6. The masticatory disturbance of each group (disc displacement with reduction, disc displacement without reduction, within normal limit) was 53％, 79％, 40％, and the trauma history of each group was 50％, 40％,60％.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.4
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• pp.337-343
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• 2001

Objective. Disc displacement may affect the joint space narrowing between condyle head and glenoid fossa. This study was designed to evaluate the correlation between the joint space change and the directions of disc displacement. Study Design. Two hundreds temporomandibular joints MR images of TMD patients (170 joints) and asymptomatic volunteers (30 joints) were evaluated for this purpose. Anterior disc displacement was divided into 3 stages (normal, little to mild, and moderate to severe displacement) based on sagittal images. And sideways displacement was classified as 3 categories (center, medial and lateral displacement) based on coronal images, then joint spaces were measured at medial, central and lateral parts of condyle head on coronal MR images, respectively. The joint spaces of 7 groups divided according to the severity and the direction of disc displacement were compared. Results. The reduction of the joint space was affected by sideways disc displacement at the opposite side of the condyle head, except the cases accompanied with severe anteriorly and laterally displaced disc. Conclusion. The sideways disc displacement affected on the opposite side temporomandibular joint space width.

• Imaging Science in Dentistry
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• v.36 no.1
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• pp.17-24
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• 2006

Purpose : The objective of this study was to investigate the effect of TMJ disc displacement on the TMJ disc configuration and surrounding osseous structure. Materials and Methods : The proton density and 72-weighted MR images of 57 TMJs were retrospectively studied. These TMJs were divided into three groups according to the anterior disc displacement status on MR sagittal images, those were the normal, anterior disc displacement with reduction (ADWR), anterior disc displacement without reduction (ADWOR). The frequency of disc configuration and surrounding bony change, the border status between articular disc and retrodiscal tissue were investigated according to the positional change of articular disc. Results : There were significant statistical differences of chi-square statistics of TMJ disc configurational type between normal and ADWR/ADWOR group, respectively. Surrounding bony change frequently appeared in ADWOR and a statistically significant difference of chi-square statistics of bony change frequency between normal and ADWOR group was observed. Conclusion : These results suggested that the disc configuration and bony change of TMJ are strongly related to TMJ disc displacement.

• The Journal of Korean Academy of Prosthodontics
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• v.39 no.4
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• pp.410-416
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• 2001

Objective: Disc displacement may affect the joint space narrowing between condylar head and glenoid fossa. This study was designed to evaluate the correlation between the joint space change and the severity of anterior disc displacement. Materials and Methods: Two hundreds temporomandibular joints MR images of TMD patients(170 joints) and asymptomatic volunteers(30 joints) were evaluated for this purpose. Anterior disc displacement was divided into 3 stages(normal, little to mild, and moderate to severe displacement) based on sagittal images, then joint spaces were measured at medial, central and lateral parts of condyle head on coronal MR images, respectively The joint spaces of 3 groups divided according to the severity of anterior disc displacement were compared. Results: The reduction of joint space was related to the severity of the anterior disc displacement at lateral, medial side and especially at center Conclusion: The temporomandibular joint space was affected by the severity of the anterior disc displacement.

• Imaging Science in Dentistry
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• v.31 no.4
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• pp.235-240
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• 2001

Purpose: To evaluate displacement and morphologic changes of the temporomandibular joint (TMJ) disc in patient with internal derangement using magnetic resonance imaging (MRI). Materials and Methods: One hundred and forty five MR images of TMJs in 73 patients were evaluated. Positional and morphologic changes of the TMJ discs were assessed. Lateral or medial disc displacement was also evaluated on coronal images. Results: Among 63 discs with anterior disc displacement, 37 discs were assessed as a biconcave disc and 21 as a deformed disc. Rotational disc displacement was observed in 35 discs. Anteromedial disc displacement was observed in 29 discs, and anterolateral direction in 6 discs. Among 35 rotational displacement, 5 biconcave discs and 21 deformed discs were observed. Conclusion : Rotational and sideways displacement of TMJ discs were found to be common and an important aspect of internal derangement. This study also suggests that sagittal and coronal images of the TMJ have complementary abilities for an assessment of joint abnormality.

• The Journal of the Korean dental association
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• v.58 no.6
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• pp.364-376
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• 2020

Internal derangement of the temporomandibular joint (TMJ) is condition in which articular disc has become displaced from its normal functional relationship with the mandibular condyle and the articular portion of the temporal bone. Common types of internal derangement include disc displacement with reduction (with or without intermittent locking), and disc displacement without reduction (with or without limited opening) classified according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Treatment varies depending on diagnosis. Therefore, differential diagnosis should be made for appropriate treatment.

• Journal of Oral Medicine and Pain
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• v.25 no.2
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• pp.173-189
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• 2000

The purpose of this study was to evaluate the effect of specific head positions on the mandibular rotational torque movements in maximum mouth opening, protrusion and lateral excursion. Thirty dental students without any sign or symptom of temporomandibular disorders(TMDs) were included as a control group and 90 patients with TMDs were selected and examined by routine diagnostic procedure for TMDs including radiographs and were classified into 3 subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Mandibular rotational torque movements were observed in four head postures: upright head posture(NHP), upward head posture(UHP), downward head posture(DHP), and forward head posture(FHP). For UHP, the head was inclined 30 degrees upward: for DHP, the head was inclined 30 degrees downward: for FHP, the head was positioned 4cm forward. These positions were adjusted with the use of cervical range-of-motion instrumentation(CROM, Performance Attainment Inc., St. Paul, U.S.A.). Mandibular rotational torque movements were monitored with the Rotate program of BioPAK system (Bioresearch Inc., WI, U.S.A.). The rotational torque movements in frontal and horizontal plane during mandibular border movement were recorded with two parameters: frontal rotational torque angle and horizontal rotational torque angle. The data obtained was analyzed by the SAS/Stat program. The obtained results were as follows : 1. The control group showed significantly larger mandibular rotational angles in UHP than those in DHP and FHP during maximum mouth opening in both frontal and horizontal planes. Disc displacement with reduction group showed significantly larger mandibular rotational angles in DHP and FHP than those in NHP during lateral excursion to the affected and non-affected sides in both frontal and horizontal planes(p<0.05). 2. Disc displacement without reduction group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening as well as lateral excursion to the affected and non-affected sides in both frontal and horizontal planes. Degenerative joint disease group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening, protrusion and lateral excursion in both frontal and horizontal planes(p<0.05). 3. In NHP, mandibular rotational angle of the control group was significantly larger than that of any other patient subgroups. Mandibular rotational angle of disc displacement with reduction group was significantly larger than that of disc displacement without reduction group during maximum mouth opening in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group or degenerative joint disease group during maximum mouth opening in the horizontal plane(p<0.05). 4. In NHP, mandibular rotational angles of disc displacement without reduction group were significantly larger than those of the control group or disc displacement with reduction group during lateral excursion to the affected side in both frontal and horizontal planes. Mandibular rotational angle of disc displacement without reduction group was significantly smaller than that of the control group during lateral excursion to the non-affected side in frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group during lateral excursion to the non-affected side in the horizontal plane(p<0.05). 5. In NHP, mandibular rotational angle of the control group was significantly smaller than that of disc displacement with reduction group or disc displacement without reduction group during protrusion in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of the disc displacement with reduction group or degenerative joint disease group during protrusion in the horizontal plane. Mandibular rotational angle of the control group was significantly smaller than that of disc displacement without reduction group or degenerative joint disease group during protrusion in the horizontal plane(p<0.05). 6. In NHP, disc displacement without reduction group and degenerative joint disease group showed significantly larger mandibular rotational angles during lateral excursion to the affected side than during lateral excursion to the non-affected side in both frontal and horizontal planes(p<0.05). The findings indicate that changes in head posture can influence mandibular rotational torque movements. The more advanced state is a progressive stage of TMDs, the more influenced by FHP are mandibular rotational torque movements of the patients with TMDs.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.28 no.1
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• pp.205-213
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• 1998

This study was designed to reveal the correlationship between the internal derangement state of TMJ and clinical characteristics including pain and mandibular dysfunction. One hundred and twenty five subjects with TMJ signs and symptoms were chosen for two years. The level of pain and madibular dysfunction were evaluated by Visual Analog Scale(VAS) and Craniomandibular Index(CMI). The diagnostic categories of TMJ internal derangement were determined by arthrography and they included normal disc position, anterior disc displacement with reduction(ADDR), rotational disc displacement with reduction (RDDR), anterior disc displacement without reduction(ADDNR), and rotational disc displacement without reduction(RDDNR). Also disc perforation was used as a criteria to divide the diagnostic subgroups. The obtained results were as follows; 1. The patient distribution of each group was 5 in normal disc position(4％), 40 in ADDR(32％), 30 in RDDR(24％), 34 in ADDNR(27％), and 16 in RDDNR(13％). 2. Perforation was observed in 8％ of ADDR, 10％ of RDDR, 32％ of ADDNR, and 19％ of RDDNR. 3. CMI of non-reduction group was higher than that of reduction or normal group(p<0.05), but V AS showed no significant difference.4. CMI of perforation group was higher than that of non-perforation group in reduction group (p<0.05). 5. There were no significant differences of CMI and VAS between anterior disc displacement group and rotational disc displacement group in both reduction and non-reduction group. 6. CMI of RDDNR group was higher than that of RDDR group(p<0.05). 7. There were no significant difference of CMI and VAS between bilateral involvement group and unilateral involvement group(p<0.05).

• Imaging Science in Dentistry
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• v.31 no.3
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• pp.145-151
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• 2001

Purpose : To investigate the hypothesis that the morphology of the articular eminence of the temporomandibular joint is a predisposing factor for disc displacement. Materials and Methods: MR images of 126 temporomandibular joints in 94 patients were analyzed to assess for morphology of the articular eminence and disc displacement. The displaced disc was further categorized as disc displacement with reduction (DDWR) and disc displacement without reduction (DDWOR). The morphology of the articular eminence was classified into four types; box, sigmoid, flattened, and deformed. The relationship between the four types of shape of the articular eminence and the two types of disc position was assessed. Results: In the DDWR and DDWOR groups, the morphology of articular eminence were a box type in 40.5%, a sigmoid type in 30.2%, a flattened type in 24.6%, and a deformed type in 4.7%. The box type of the articular eminence were 34.3% in the DDWR group and 42.9% in the DDWOR group. The sigmoid type of the articular eminence were 34.3% in the DDWR group and 28.6% in the DDWOR group. The flattened type of the articular eminence were 28.6% in the DDWR group and 23.1 % in the DDWOR group. The deformed type of articular eminence were 2.9% in the DDWR group and 5.5% in the DDWOR group. Conclusion: Disc displacement is more likely to be found in the temporomandibular joints with a box-shaped articular eminence. It can be considered that shape of the articular eminence is related to the development of disc displacement.