• Imaging Science in Dentistry
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• v.42 no.4
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• pp.249-253
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• 2012

Purpose: Diagnosis of osteoarthritis most commonly depends on clinical and radiographic findings. The present study attempted to observe the bony changes in temporomandibular joint (TMJ) patients from all age groups. Materials and Methods: The first-visit clinical records and cone beam computed tomography (CBCT) data of 440 TMJs from 220 consecutive TMJ patients were reviewed retrospectively. Results: The most frequent condylar bony change observed was sclerosis (133 joints, 30.2%) followed by surface erosion (129 joints, 29.3%), flattening of the articular surface (112 joints, 25.5%), and deviation in form (58 joints, 13.2%), which included 33 TMJs in a cane-shape, 16 with a lateral or medial pole depression, 6 with posterior condylar surface flattening, and 3 with a bifid-shaped condyle. Fifty-three joints (12.0%) showed hypoplastic condyles but only 1 joint showed hyperplasia. Osteophyte was found in 35 joints (8.0%) and subcortical cyst in 24 joints (5.5%), 5 of which had surface erosion as well. One hundred nineteen joints (27.0%) had only one kind of condylar bony change, 66 joints (15.0%) had two, 52 joints (11.8%) had three, 12 joints (5.0%) had four, and 6 joints (1.4%) had five kinds of condylar bony changes at the same time. Eighty-five (65.9%) of 129 joints with surface erosion had pain recorded at the chief complaint. Conclusion: With more widespread use of CBCT, more specific or detailed guidelines for osteoarthritis are needed.

• Journal of Oral Medicine and Pain
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• v.48 no.3
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• pp.123-130
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• 2023

This case report describes the orthodontic treatment of a patient with severe anterior open bite and skeletal class II malocclusion with temporomandibular joint (TMJ) osteoarthritis (OA) of the left condyle. The 21-year-old male patient had open-bite malocclusion, mild crowding, and protrusion of the anterior teeth. Mild erosive changes were detected in the anterior part of the left mandibular condyle on cone-beam computed tomography; however, because no clinical symptoms were present, orthodontic treatment was performed. It is imperative to consider the potential implications of orthodontic treatment on the stability of the TMJ throughout the duration of treatment, as any instability can exacerbate TMJ OA. Hence, it is crucial to opt for the least invasive treatment modality available. In this regard, orthodontic treatment using a skeletal anchorage system as an alternative to conventional orthognathic surgery for patients with open bite holds great promise, as it not only ensures mandibular stability but also significantly ameliorates the open-bite condition.

• Journal of Oral Medicine and Pain
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• v.23 no.4
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• pp.379-385
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• 1998

A patient with TMJ osteoarthritis and anterior open bite was treated with an intermaxillary traction device. Pretreatment examination revelaed a pain in both TMJ during mouth opening, moderate tendernesso f left sternocleidomastoid and right trapezius muscles. Anterior open Bite was aobserved with interincisal distance of 2mm. Tomograms and MRI showed anterior disc displacement withouit reductoin of both temporomandibular joints, and the condyles were flattened and slightly eroded. A pair of full-coverage occlusal appliances was made on both maxillary and mandibular dentition, with pivoting fulcrum on the site of the second moalr. Traction force was gained by the intermaxillary orthodontic elastics which were hooked by orthodontic brackets on the labial surfaces of the upper and lower anterior and premolar teeth. After 8 weeks of traction treatment, the joint pain was subsided completely and the anterior open bite was closed to get an edge to edge relationship of anterior teeth.

• Imaging Science in Dentistry
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• v.31 no.3
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• pp.159-164
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• 2001

Purpose: To evaluate the osseous changes of TMJ in internal derangement and osteoarthritis patients using MRI. Materials and Methods: MR images of 111 TMJs in 64 patients were analyzed to evaluate the osseous changes, 111 TMJs were divided into 6 groups according to the radiologic Stages by Schellhas and Wilkes. On MR images, we evaluate the osseous changes of articular eminence and condylar head. Results: The most frequent Stage in internal derangement of TMJ was Stage I. And 28 joints (25.2%) revealed osteoarthritis with internal derangement. When osseous change of articular eminence and condylar head occur, flattening was the most common osseous change. Sclerosis was observed in all Stages and osteophytosis of condylar head was observed in Stage II (1.8%) and III (0.9%). Out of 28 joints with osteoarthritis, 6 joints (21.4%) showed joint effusion. Conclusion: MR image revealed abnormal configuration of disk, but the detection of minimal osseous change was subtle.

• Journal of Oral Medicine and Pain
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• v.41 no.2
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• pp.48-53
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• 2016

Purpose: The purpose of this study was to compare the differences in clinical signs and symptoms, and psychological profiles of temporomandibular joint osteoarthritis (TMJ OA) between juvenile and adult patients. Methods: Two-hundred eighty-three TMJ OA patients who visited the Orofacial Pain Clinic of Seoul National University Dental Hospital were classified by juvenile (153 patients; mean age $14.2{\pm}1.7$ years, range 9-16 years) and adult (130 patients; mean age $34.0{\pm}2.8$ years, range 30-40 years) groups, and compared the clinical symptoms based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I guidelines including Graded Chronic Pain (GCP) scale, mandibular range of motion, and the associated symptoms. Psychological profiles were also evaluated using the Symptom Checklist 90-Revision (SCL-90-R). Results: Juvenile patients reported lower pain intensity and a lower prevalence of headache and clenching than adult patients. Their mandibular range of motion was also higher than adult patients. Juvenile patients showed a lower percentage of patients with T-score above 50 in somatization (SOM), obsessive-compulsive (O-C), interpersonal sensitivity (I-S), and paranoid ideation (PAR) than adults. Based on the GCP scale, the percentage of the high disability group was lower in juveniles. Conclusions: Juvenile TMJ OA patients generally showed milder clinical symptoms than adults. Adult patients showed higher prevalence of psychological problems and higher disability than juvenile patients. Age should be considered in evaluation and treatment of TMJ OA patients to achieve better treatment results and understanding its pathophysiology.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.3
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• pp.174-182
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• 2020

Objectives: Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage. Materials and Methods: Twenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test. Results: Patient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 post-trauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, P<0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, P<0.001); however, concomitant conservative therapy showed no difference in treatment outcome. Conclusion: The results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.1
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• pp.50-58
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• 2022

Objectives: Osteoarthritis (OA) is the most prevalent and disabling joint disease in the world. Temporomandibular joint (TMJ) exercise is a widely used treatment and could be a beneficial and long-term tool for treating TMJ OA. The present study aims to evaluate the effects of therapeutic exercise in the conservative treatment of TMJ OA. Materials and Methods: A single-group experimental pre-post test was performed. We included patients who met the diagnostic criteria for TMJ OA. Outcome variables were pain intensity (visual analogue scale), functionality (Helkimo index), and structural changes (ultrasound). Follow-up periods were at months 1, 3, and 6. The intervention included a home-based program with thermotherapy, manual therapy, and therapeutic exercise during the entire follow-up period. Results: We included 15 patients and 26 joints, all women with a median age of 57 years (range, 49-62 years). Median change in pain intensity on joint palpation, mouth opening, and at rest at the first month was 47.5 mm, 51 mm, and 60 mm, respectively, and 48 mm, 49.5 mm, and 42.5 mm, at six months (P=0.001). The Helkimo index showed significant improvement in medians from baseline severe dysfunction (17 points) to minimal dysfunction at three and six months (2 points) (P=0.001). Ultrasound showed improved disc position. Conclusion: This study demonstrated significant improvements in pain, function, and joint disc position and represents a valuable tool for the long-term treatment of patients with TMJ OA.

• Journal of Oral Medicine and Pain
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• v.48 no.4
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• pp.152-158
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• 2023

Purpose: This pilot study aimed to evaluate changes in joint space (JS) using cone-beam computed tomography (CBCT) images of patients diagnosed with temporomandibular joint (TMJ) osteoarthritis (OA) and to determine the association between occlusal changes and JS. Methods: CBCT images were used to measure the anterior, superior, and posterior JSs of the sagittal plane. The differences in JS values over time and between groups were compared. The percentage change in the anteroposterior position of the mandibular condyle between groups was also analyzed. Results: Thirty-four subjects (mean age=43.91±20.13), comprising eight males (23.5%) and 26 females (76.5%), were divided into 18 patients with no change in occlusion (NCO) and 16 patients with a change in occlusion (CO) during TMJ OA. The JS measurements of the study subjects showed a decrease in anterior joint space (AJS) values over time. There was no difference in JS measurements between the groups at T1 and T2. AJS values measured at T1 were lower in the CO group than in the NCO group, but the difference was not statistically significant. In both groups, a posterior position of the mandibular condyle was initially observed with high frequency. However, there is a statistically significant difference in CBCT images taken after occlusal changes, with an increased frequency of condyles observed in the anterior or central positions. Conclusions: In conclusion, AJS decreased over time in TMJ OA, and the mandibular condyle became more anteriorly positioned with occlusal changes. Therefore, clinicians should diligently monitor mandibular condyle morphology and JS using CBCT, along with the patient's clinical symptoms, to treat and control TMJ OA effectively.

• Journal of Oral Medicine and Pain
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• v.47 no.3
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• pp.156-160
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• 2022

Temporomandibular joint (TMJ) ankylosis is a condition in which condylar movement is restricted because of fibrous or bony union between the mandibular condyle and temporal bone. TMJ ankylosis is most often caused by trauma, followed by systemic or local infection, and secondary to unknown causes. Diagnostic imaging plays a vital role in diagnosing TMJ ankylosis and establishing a treatment plan. Computed tomography (CT) or cone beam computed tomography (CBCT) is currently the imaging technique of choice to accurately demonstrate preoperative ankylosing masses and other surgically important findings, such as the shape of the mandibular condyle and the pathological changes in the joint. The osseous changes in the mandibular condyle are easily identified in the coronal and sagittal sections of CT or CBCT images. This report describes the case of a middle-aged woman who developed TMJ ankylosis of the left TMJ while undergoing repeated treatment for TMJ disease. We report the findings observed on radiographic and CBCT images through continuous observation.

• The Journal of the Korean dental association
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• v.40 no.6 s.397
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• pp.424-429
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• 2002