• Imaging Science in Dentistry
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• v.54 no.1
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• pp.71-80
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• 2024

Purpose: This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography. Materials and Methods: In total, 210 joints from 183 patients(144 females, 39 males, ranging from 12 to 88 years old with a mean age of 44.75±19.97 years) diagnosed with temporomandibular joint osteoarthritis were stratified by age. Mandibular condyle position and bony changes (flattening, erosion, osteophytes, subchondral sclerosis, and subchondral pseudocysts in both the condyle and articular eminence, thickening of the glenoid fossa, joint space narrowing, and joint loose bodies) were evaluated through cone-beam computed tomography. After adjusting for sex, the association between age groups and radiographic findings was analyzed using both a multiple regression model and a multinomial logistic regression model(α=0.05). Results: The prevalence of joint space narrowing and protruded condyle position in the glenoid fossa significantly increased with age (P<0.05). The risks of bony changes, including osteophytes and subchondral pseudocysts in the condyle; flattening, erosion, osteophyte, and subchondral sclerosis in the articular eminence; joint loose bodies; and thickening of the glenoid fossa, also significantly rose with increasing age (P<0.05). The number of radiographic findings increased with age; in particular, the increase was more pronounced in the temporal bone than in the mandibular condyle (P<0.05). Conclusion: Increasing age was associated with a higher frequency and greater diversity of bony changes in the temporal bone, as well as a protruded condyle position in the glenoid fossa, resulting in noticeable joint space narrowing in temporomandibular joint osteoarthritis.

• Journal of Oral Medicine and Pain
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• v.47 no.2
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• pp.95-101
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• 2022

Temporomandibular joint osteoarthritis (TMJ OA) causes destruction of the temporomandibular joint (TMJ) and can lead to occlusal changes such as anterior open bite in some patients. Consequently, these patients may experience difficulty in chewing food items and exhibit abnormal functional habits such as bruxism, preventing healing of the TMJ condyles. Treatment protocols include the use of traction appliances to reduce stress on the condyles. Unstable occlusions can lead to weakness of the masticatory muscles which, in turn, worsen the occlusal changes and complicate pain management. Therefore, the current study evaluated the condition of the masseter muscle using ultrasonography and educated patients on the execution of gum-chewing exercises for muscle strengthening. It also aimed to assess the effects of traction appliances and strengthening exercises on the masticatory muscles of patients with occlusal changes caused by TMJ OA.

• Journal of Oral Medicine and Pain
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• v.47 no.1
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• pp.67-71
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• 2022

Subchondral cysts are frequently encountered in patients with temporomandibular joint osteoarthritis (TMJ OA), particularly in advanced stage. Subchondral cysts within osteoarthritis are typically lying adjacent to the joint surface where initial load bearing occurs during activity and have been associated with greater pain and disease progression. Although the etiology of these cysts remains uncertain, recently studies report that the induction of the subchondral bone mechanical stress caused subchondral cysts. Repeated overloading leads to further deterioration of subchondral bone which render subchondral bone structure more fragile, increase the risk of osteoarthritis progress. The purpose of this study was to assess the effect of conservative treatment and longitudinal osseous changes of a large subchondral cyst in a mandibular condyle in a symptomatic TMJ OA patient.

• Journal of dental hygiene science
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• v.18 no.2
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• pp.124-129
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• 2018

The purpose of this study was to examine the association between the symptoms of temporomandibular joint disorders and lumbar diseases in adults when the prevalence rate of osteoarthritis is increasing and to help develop health policies that can improve oral health and health in general. The study used representative data from the 5th Korea National Health and Nutrition Examination Survey phase 3 (2012). In total, we analyzed the data of 3,017 individuals aged over 50 years who participated in the health-related survey and underwent radiography of the lumbar joints. PASW statistics ver. 18.0 was used for analysis. This study revealed the following results: 16.1% experienced at least one symptom of temporomandibular joint disorders within the recent single year, 20.6% experienced lower back pain in the recent three months, and 30.6% had lumbar osteoarthritis revealed using radiography of the lumbar joints. Symptoms of temporomandibular joint disorders, lower back pain, and lumbar osteoarthritis were correlated with each other; the respondents who experienced symptoms of temporomandibular joint disorders had 1.70 times (95% confidence interval [CI], 1.30~2.22) higher prevalence of lower back pain and 1.20 times (95% CI, 0.86~1.68) higher prevalence of lumbar osteoarthritis than in those with no such difficulties. The results of this study confirmed that the symptoms of temporomandibular joint disorders affected lumbar diseases in adulthood. Therefore, adequate treatment and prevention of the symptoms of temporomandibular joint disorders in adults is expected to make crucial contributions to decreases in the prevalence rate of lumbar diseases and an improvement in the quality of life.

• Imaging Science in Dentistry
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• v.53 no.4
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• pp.355-363
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• 2023

Purpose: Sonographic elastography can be used to evaluate the hardness of muscle tissue through the application of compression. Strain elastography gauges hardness through the comparison of echo sets before and after compression. This study utilized ultrasonography to measure the thickness and hardness of the masseter muscle in individuals with temporomandibular joint(TMJ) osteoarthritis. Materials and Methods: This study included 40 patients who presented with joint pain and were diagnosed with TMJ osteoarthritis via diagnostic cone-beam computed tomography, along with 40 healthy individuals. The thickness and hardness of each individual's masseter muscle were evaluated both at rest and at maximum bite using ultrasonography. The Mann-Whitney U test and the chi-square test were employed for statistical analysis, with the significance level set at P<0.05. Results: The mean thickness of the resting masseter muscle was 0.91 cm in patients with osteoarthritis, versus 1.00 cm in healthy individuals. The mean thickness of the masseter muscle at maximum bite was 1.28 cm in osteoarthritis patients and 1.36 cm in healthy individuals. The mean masseter elasticity index ratio at maximum bite was 4.51 in patients with osteoarthritis and 3.16 in healthy controls. Significant differences were observed between patients with osteoarthritis and healthy controls in both the masseter muscle thickness and the masseter elasticity index ratio, at rest and at maximum bite (P<0.05). Conclusion: The thickness of the masseter muscle in patients with TMJ osteoarthritis was less than that in healthy controls. Additionally, the hardness of the masseter muscle was greater in patients with TMJ osteoarthritis.

• Imaging Science in Dentistry
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• v.50 no.3
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• pp.245-253
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• 2020

Purpose: This study investigated the prevalence of temporomandibular joint osteoarthritis (TMJ-OA) using the Research Diagnostic Criteria for Temporomandibular Disorders image analysis criteria, assessed the severity of incidental osteoarthritic changes affecting the TMJ, and evaluated the correlations of sex and age with the prevalence and severity of TMJ-OA. Materials and Methods: This retrospective study assessed 145 randomly selected cone-beam computed tomography scans (261 TMJs) from the authors' institutional maxillofacial radiology archive following the application of inclusion and exclusion criteria. The criteria described by Ahmad et al. were used to determine whether each TMJ was affected by OA, and the severity of the osteoarthritic changes was scored for each joint based on the method described by Alexiou et al. The chi-square, McNemar, Bhapkar chi-square, and Stuart-Maxwell chi-square tests were applied to evaluate the significance of the relationships between variables(age and sex). Results: Sixteen TMJs (6.1%) had no OA, 74 (28.6%) were indeterminate for OA, and 171 (65.5%) had OA. Flattening and sclerosis were observed in 86.6% and 12.3% of cases, respectively, while resorption was observed in 7.3% of the joints. Only 21 (8.1%) of the examined TMJs had subchondral cysts. Erosion of the articular eminence was observed in 58 (22.1%) cases, while sclerosis and resorption were found in 68 (25.9%) and 16 (6.1%) TMJs, respectively. Conclusion: Female patients had a higher prevalence and severity of TMJ-OA than male patients. The prevalence and severity of TMJ-OA increased with age, with peaks in the fifth and seventh decades of life.

• Journal of Oral Medicine and Pain
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• v.42 no.2
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• pp.35-43
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• 2017

Purpose: This study aims to evaluate the correlation between joint sounds and radiographic bone change patterns along with clinical symptoms of temporomandibular joint osteoarthritis (TMJ OA) patients. Methods: The patients for this study were over 19 years of age, diagnosed tentatively with TMJ OA. The patients were examined with temporomandibular disorders analysis test and all three radiographs, including panoramic radiography, transcranial radiography, and cone beam computed tomography (CBCT). Information of the patients' age, pain status, joint sound and mouth opening range were collected. And bone change pattern was examined by reviewing panoramic radiography, transcranial radiography and CBCT images. Results: The patients with crepitus had a higher average active mouth opening (AMO) range than patients without crepitus, and the group with bilateral crepitus had a higher average AMO range than the group with unilateral crepitus (p<0.001). And the patient with pain during mastication was increased in the group with clicking than the group without clicking, and the group with bilateral clicking showed a statistically significant increase in the patient with pain during mastication than the group with unilateral clicking (p<0.05). The analytical results of the relevance of crepitus showed a high correlation with bone change observed from each of the three radiographs. And the agreement in bone change findings from 3 groups of paired radiographs showed high agreement (p<0.001). Meanwhile, 77.2% of CBCT findings showed bone change of condyle without crepitus (p<0.001). Conclusions: This study presented significant results in the evaluation of the correlation with crepitus and bone change of TMJ OA patients from panoramic radiography or transcranial projection. However, the accurate assessment is required through CBCT for the patient with complains of persistent pain, limitation of mouth opening, and occlusal change even if the crepitus does not exist.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.3
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• pp.120-127
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• 2018

Objectives: The aim of this study was to reveal how collagenases (matrix metalloproteinase [MMP]-1, 8, 13) and tissue inhibitor of metalloproteinase 1 (TIMP-1) are expressed in immunohistochemistry of retrodiscal tissue in temporomandibular joint disorder patients. Materials and Methods: This study was conducted on 39 patients who underwent discoplasty or discectomy. Immunohistochemical staining was undertaken and expression levels of MMP-1, 8, 13, and TIMP-1 were evaluated. The status of internal derangement of disc, osteoarthritis, and joint effusion were analyzed using magnetic resonance imaging (MRI). Disc status observed during operation was also categorized. Results: The more severe disc derangement was observed on MRI, the more increased expression of MMPs and TIMP-1 appeared. Regarding MMP-13 expression, 86.7% of late-stage disc displacement patients showed grade II or III. Expression level of MMPs or TIMP was not statistically significant associated with joint effusion level. In perforation and/or adhesion groups, all patients showed grade II or III expression of MMP-13. Once perforation occurred, MMP-13 showed increased expression with statistical significance. Conclusion: MMP-1 and MMP-13 expression seem to be related to progression of osteoarthritis whereas MMP-8 does not seem to have a specific role with regard to temporomandibular joint disorders. TIMP-1 is considered to be partly related to internal derangement rather than osteoarthritis, but it is not significant.

• Journal of Oral Medicine and Pain
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• v.44 no.2
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• pp.45-53
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• 2019

Purpose: To determine whether crepitus may be a clinical indication for early temporomandibular joint (TMJ) osteoarthritis (OA) and to investigate the correlation between crepitus and the occurrence of TMJ OA with respect to factors, such as patient sex, age, chewing habits, and diagnosis. Methods: This is retrospective analysis of clinical data for 162 TMJs. The criteria for a joint to be included in this study was a minimum of two cone-beam computed tomography (CBCT) scans performed with no OA observed during the initial scan. The Diagnostic Criteria for Temporomandibular Disorders was used for OA diagnosis. Crepitus was recorded when it was objectively palpated during the follow-up period. Correlations between various patient factors and progression to TMJ OA were calculated using the Pearson's chi-square test. A linear-by-linear association was used to analyze trends of OA progression with increasing age. Results: Among the 162 joints, 101 progressed to OA and 61 did not. In the joints where crepitus had been present before OA was confirmed at next or last CBCT, OA progressed at a high rate, and especially higher in female and older patients (p<0.01). Patients in the pain-related disorder group with crepitus were observed to have higher rates of OA progression compared to patients in the intra-articular disorder group (p<0.01). Conclusions: If a patient experiences pain in the TMJs and crepitus, close monitoring through regular CBCT scans is necessary even if there is no evidence of radiologically confirmed OA after the first CBCT.

• The korean journal of orthodontics
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• v.45 no.3
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• pp.136-145
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• 2015

This case report describes the orthodontic treatment performed for open bite caused by internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). A Japanese woman, aged 31 years and 11 months, referred to our department by an oral surgeon had an open bite with clockwise rotation of the mandible and degeneration of the condyle. The overbite was corrected through intrusion of the maxillary and mandibular molars using mini-screw implants to induce counterclockwise rotation of the mandible. Then, the mandibular second premolars were extracted and comprehensive orthodontic treatment was performed to establish a Class I molar relationship with distalization of the maxillary arch and to eliminate anterior crowding. Following treatment, her facial profile improved and a functional and stable occlusion was achieved without recurrence of the TMJ symptoms. These results suggest that orthodontic intrusion of the molars is one of the safer and less stressful alternatives for the management of open bite due to degeneration of the condyles caused by ID and OA of TMJ.