Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Efficacy of Panoramic Radiography in Determining Bony Changes in Temporomandibular Joint
Panoramik Radyografinin Temporomandibular Eklem Kemik Değişikliklerini Belirlemedeki Etkinliğinin Değerlendirilmesi
Melike BAŞARANa, Sinem Sırlı YILMAZTÜRKb, Esin BOZDEMİRb
aDepartment of Oral and Maxillofacial Radiology, Kütahya Health Sciences University Faculty of Dentistry, Kütahya, TURKEY
bDepartment of Oral and Maxillofacial Radiology, Süleyman Demirel University Faculty of Dentistry, Isparta, TURKEY
Turkiye Klinikleri J Dental Sci. 2021;27(1):6-14
doi: 10.5336/dentalsci.2019-72888
Article Language: EN
Full Text
ABSTRACT
 Objective: To investigate the utility of panoramic radiography in determining bony changes in temporomandibular joint (TMJ) based on cone-beam computed tomography (CBCT) images. Material and Methods: Two hundred eight TMJs on panoramic radiography and CBCT images of 104 (55 male, 49 female) patients were examined. Erosion, flattening, subcortical sclerosis or cyst, osteophyte, loose joint bodies, generalized sclerosis and deviation in form on the mandibular condyle, flattening, subcortical sclerosis and erosion of the articular eminence and articular fossa were evaluated both on CBCT and panoramic images. Data were scored as follows: false positive, false negative, true positive and true negative, and statistically analyzed with SPSS software using chi-square test (p<0.05), Cohen's kappa, receiving operating characteristic curve analysis. Results: Flattening (51.4% on CBCT, 24% on panoramic) and erosion (50% on CBCT, 15.9% on panoramic) was most commonly detected on the condylar head (p˂0.05). In the articular eminence, flattening in 2.4% and erosion in 12.5% and the articular fossa flattening in 1% and erosion in 20.2% were detected on CBCT. Flattening and erosion of the articular eminence and articular fossa could not be determined by panoramic radiography. Bony change that the most (38.5%) scored as the false negative was erosion. Accuracy values of panoramic radiography for the detection of any osseous change was poor compared with CBCT images (≤50%). Conclusion: Panoramic radiography was inadequate for detecting bony changes in TMJ especially in articular eminence and articular fossa. Therefore, radiological examination should be supported with more reliable imaging modalities like CBCT to examine hard tissues of TMJ.

Keywords: Cone-beam computed tomography; osteoarthritis; radiography; panoramic; temporomandibular joint disorders
ÖZET
 Amaç: Bu çalışmanın amacı, konik ışınlı bilgisayarlı tomografi (KIBT) görüntüleri baz alınarak, panoramik radyografinin temporomandibular eklemde (TME) görülen kemik değişikliklerini saptamadaki etkinliğinin değerlendirilmesidir. Gereç ve Yöntemler: Panoramik radyografi ve KIBT görüntüleri üzerinde 104 hastaya (55 erkek, 49 kadın) ait 208 TME incelendi. Mandibular kondilde erozyon, düzleşme, subkortikal skleroz veya kist, osteofit, serbest cisimler (loose bodies), generalize skleroz ve kondil başında deviasyon ile artiküler eminens ve artiküler fossada düzleşme, subkortikal skleroz ve erozyon varlığı değerlendirildi. Veriler yanlış pozitif, yanlış negatif, doğru pozitif ve doğru negatif olarak skorlandı ve ki-kare testi (p<0,05), Cohen kappa ve alıcı işlem karakteristik analizi kullanılarak SPSS yazılımı ile istatistiksel olarak analiz edildi. Bulgular: Mandibular kondilde en sık düzleşme (KIBT'de %51,4; panoramikte %24) ve erozyon (KIBT'de %50; panoramikte %15,9) saptandı (p˂0,05). KIBT görüntülerinde artiküler eminenste %2,4 oranında düzleşme ve %12,5 oranında erozyon, artiküler fossada %1 oranında düzleşme ve %20,2 oranında erozyon tespit edildi. Panoramik radyografi görüntülerinde artiküler eminenste ve artiküler fossada düzleşme ve erozyon saptanmadı. Tüm parametreler için doğru negatif skorlama oranı en yüksekti. En çok (%38,5) yanlış negatif olarak skorlanan kemik değişikliği erozyondu. Kemik değişikliklerinin saptanmasında panoramik radyografinin doğruluk değeri, KIBT'ye oranla daha azdı (≤%50). Sonuç: Panoramik radyografinin, TME'de özellikle artiküler eminens ve fossada görülen kemik değişikliklerini saptamada yetersiz olduğu saptandı. Bu nedenle radyolojik inceleme, TME'nin sert dokularını incelemek için KIBT gibi daha güvenilir görüntüleme yöntemleriyle desteklenmelidir.

Anahtar Kelimeler: Konik ışınlı bilgisayarlı tomografi; osteoartrit; radyografi; panoramik; temporomandibular eklem bozuklukları
REFERENCES:
  1. Shahidi S, Salehi P, Abedi P, Dehbozorgi M, Hamedani S, Berahman N. Comparison of the bony changes of TMJ in patients with and without TMD complaints using CBCT. J Dent (Shiraz). 2018;19(2):142-9.[PubMed] [PMC] 
  2. Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(6):844-60.[Crossref] [PubMed] [PMC] 
  3. dos Anjos Pontual ML, Freire JS, Barbosa JM, Frazão MA, dos Anjos Pontual A. Evaluation of bone changes in the temporomandibular joint using cone beam CT. Dentomaxillofac Radiol. 2012;41(1):24-9.[Crossref] [PubMed] [PMC] 
  4. Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol. 2009;38(3):141-7.[Crossref] [PubMed] 
  5. Al-Ekrish AA, Al-Juhani HO, Alhaidari RI, Alfaleh WM. Comparative study of the prevalence of temporomandibular joint osteoarthritic changes in cone beam computed tomograms of patients with or without temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(1):78-85.[Crossref] [PubMed] 
  6. Cömert Kiliç S, Kiliç N, Sümbüllü MA. Temporomandibular joint osteoarthritis: cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg. 2015;44(10):1268-74.[Crossref] [PubMed] 
  7. Talaat W, Al Bayatti S, Al Kawas S. CBCT analysis of bony changes associated with temporomandibular disorders. Cranio. 2016;34(2):88-94.[Crossref] [PubMed] 
  8. Bell WE. Temporomandibular Disorders: Classification, Diagnosis, Management. 2nd ed. London: Year Book Medical Publishers; 1986.
  9. Epstein JB, Caldwell J, Black G. The utility of panoramic imaging of the temporomandibular joint in patients with temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(2):236-9.[Crossref] [PubMed] 
  10. Petersson A. What you can and cannot see in TMJ imaging--an overview related to the RDC/TMD diagnostic system. J Oral Rehabil. 2010;37(10):771-8.[Crossref] [PubMed] 
  11. Magnusson T, Karlsson C. Clinical impact of radiological examinations of patients with suspected temporomandibular disorders. Swed Dent J. 2002;26(2):67-74.[PubMed] 
  12. Maclure M, Willett WC. Misinterpretation and misuse of the kappa statistic. Am J Epidemiol. 1987;126(2):161-9.[Crossref] [PubMed] 
  13. Barghan S, Tetradis S, Mallya S. Application of cone beam computed tomography for assessment of the temporomandibular joints. Aust Dent J. 2012;57 Suppl 1:109-18.[Crossref] [PubMed] 
  14. Kohli S, Sharma RK, Goel A, Sunil M. Evaluation of temporomandibular joint disorders using cone beam computed tomography. International Journal of Research in Orthopaedics 2017;3(4):698.[Crossref] 
  15. Lascala CA, Panella J, Marques MM. Analysis of the accuracy of linear measurements obtained by cone beam computed tomography (CBCT-NewTom). Dentomaxillofac Radiol. 2004;33(5):291-4.[Crossref] [PubMed] 
  16. Perschbacher S. Temporomandibular joint abnormalities. In: White SC, Pharoah MJ, eds. Oral Radiology: Principles and Interpretation. 7th ed. St Louis: Elsevier Health Sciences; 2014. p.492-521.[Crossref] 
  17. Im YG, Lee JS, Park JI, Lim HS, Kim BG, Kim JH. Diagnostic accuracy and reliability of panoramic temporomandibular joint (TMJ) radiography to detect bony lesions in patients with TMJ osteoarthritis. Journal of Dental Sciences 2018;13(4):396-404.[Crossref] [PubMed] [PMC] 
  18. Christiansen EL, Thompson JR, Hasso AN. CT evaluation of trauma to the temporomandibular joint. J Oral Maxillofac Surg. 1987;45(11):920-3.[Crossref] [PubMed] 
  19. Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG, Omnell KA, et al. Imaging of the temporomandibular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(5):609-18.[Crossref] [PubMed] 
  20. Dahlström L, Lindvall AM. Assessment of temporomandibular joint disease by panoramic radiography: reliability and validity in relation to tomography. Dentomaxillofac Radiol. 1996;25(4):197-201.[Crossref] [PubMed] 
  21. Honda K, Larheim TA, Maruhashi K, Matsumoto K, Iwai K. Osseous abnormalities of the mandibular condyle: diagnostic reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material. Dentomaxillofac Radiol. 2006;35(3):152-7.[Crossref] [PubMed] 
  22. Ma RH, Yin S, Li G. The detection accuracy of cone beam CT for osseous defects of the temporomandibular joint: a systematic review and meta-analysis. Sci Rep. 2016;6:34714.[Crossref] [PubMed] [PMC] 
  23. Aksoy S, Orhan K. [Imaging methods for temporomandibular joint]. Ondokuz Mayıs Üniversitesi Diş Hekimliği Fakültesi Dergisi 2010;11(2):69-78.[Link] 
  24. Tsiklakis K, Syriopoulos K, Stamatakis HC. Radiographic examination of the temporomandibular joint using cone beam computed tomography. Dentomaxillofac Radiol. 2004;33(3):196-201.[Crossref] [PubMed] 
  25. Katakami K, Shimoda S, Kobayashi K, Kawasaki K. Histological investigation of osseous changes of mandibular condyles with backscattered electron images. Dentomaxillofac Radiol. 2008;37(6):330-9.[Crossref] [PubMed] 
  26. Librizzi ZT, Tadinada AS, Valiyaparambil JV, Lurie AG, Mallya SM. Cone-beam computed tomography to detect erosions of the temporomandibular joint: Effect of field of view and voxel size on diagnostic efficacy and effective dose. Am J Orthod Dentofacial Orthop. 2011;140(1):e25-30.[Crossref] [PubMed] 
  27. Kim K, Wojczyńska A, Lee JY. The incidence of osteoarthritic change on computed tomography of Korean temporomandibular disorder patients diagnosed by RDC/TMD; a retrospective study. Acta Odontol Scand. 2016;74(5):337-42.[Crossref] [PubMed] 
  28. Koyama J, Nishiyama H, Hayashi T. Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder. Dentomaxillofac Radiol. 2007;36(8):472-7.[Crossref] [PubMed] 
  29. Yasuoka T, Nakashima M, Okuda T, Tatematsu N. Effect of estrogen replacement on temporomandibular joint remodeling in ovariectomized rats. J Oral Maxillofac Surg. 2000;58(2):189-96.[Crossref] [PubMed] 
  30. Wadhwa S, Kapila S. TMJ disorders: future innovations in diagnostics and therapeutics. J Dent Educ. 2008;72(8):930-47.[Crossref] [PubMed] [PMC] 
  31. Milam SB. Pathophysiology and epidemiology of TMJ. J Musculoskelet Neuronal Interact. 2003;3(4):382-90.[PubMed] 
  32. Axelsson S, Fitins D, Hellsing G, Holmlund A. Arthrotic changes and deviation in form of the temporomandibular joint--an autopsy study. Swed Dent J. 1987;11(5):195-200.[PubMed] 
  33. Widmalm SE, Westesson PL, Kim IK, Pereira FJ Jr, Lundh H, Tasaki MM. Temporomandibular joint pathosis related to sex, age, and dentition in autopsy material. Oral Surg Oral Med Oral Pathol. 1994;78(4):416-25.[Crossref] [PubMed] 
  34. Magnusson C, Ernberg M, Magnusson T. A description of a contemporary human skull material in respect of age, gender, temporomandibular joint changes, and some dental variables. Swed Dent J. 2008;32(2):69-81.[PubMed] 
  35. Richards LC. Degenerative changes in the temporomandibular joint in two Australian aboriginal populations. J Dent Res. 1988;67(12):1529-33.[Crossref] [PubMed] 
  36. Pereira FJ Jr, Lundh H, Westesson PL. Morphologic changes in the temporomandibular joint in different age groups. An autopsy investigation. Oral Surg Oral Med Oral Pathol. 1994;78(3):279-87.[Crossref] [PubMed] 
  37. Zhao YP, Zhang ZY, Wu YT, Zhang WL, Ma XC. Investigation of the clinical and radiographic features of osteoarthrosis of the temporomandibular joints in adolescents and young adults. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(2):e27-34.[Crossref] [PubMed] 
  38. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41(5):778-99.[Crossref] [PubMed] 
  39. Bäck K, Ahlqwist M, Hakeberg M, Dahlström L. Occurrence of signs of osteoarthritis/arthrosis in the temporomandibular joint on panoramic radiographs in Swedish women. Community Dent Oral Epidemiol. 2017;45(5):478-84.[Crossref] [PubMed] 
  40. Crusoé-Rebello IM, Campos PS, Rubira IR, Panella J, Mendes CM. Evaluation of the relation between the horizontal condylar angle and the internal derangement of the TMJ - a magnetic resonance imaging study. Pesqui Odontol Bras. 2003;17(2):176-82.[Crossref] [PubMed] 
  41. Isberg A, Hägglund M, Paesani D. The effect of age and gender on the onset of symptomatic temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(3):252-7.[Crossref] [PubMed] 
  42. Gil C, Santos KC, Dutra ME, Kodaira SK, Oliveira JX. MRI analysis of the relationship between bone changes in the temporomandibular joint and articular disc position in symptomatic patients. Dentomaxillofac Radiol. 2012;41(5):367-72.[Crossref] [PubMed] [PMC] 
  43. Nah KS. Condylar bony changes in patients with temporomandibular disorders: a CBCT study. Imaging Sci Dent. 2012;42(4):249-53.[Crossref] [PubMed] [PMC] 
  44. Campos MI, Campos PS, Cangussu MC, Guimarães RC, Line SR. Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle. Int J Oral Maxillofac Surg. 2008;37(6):529-34.[Crossref] [PubMed] 
  45. Honey OB, Scarfe WC, Hilgers MJ, Klueber K, Silveira AM, Haskell BS, et al. Accuracy of cone-beam computed tomography imaging of the temporomandibular joint: comparisons with panoramic radiology and linear tomography. Am J Orthod Dentofacial Orthop. 2007;132(4):429-38.[Crossref] [PubMed] 
  46. Ladeira DB, da Cruz AD, de Almeida SM. Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard. Braz Oral Res. 2015;29(1):S1806-83242015000100303.[Crossref] [PubMed] 

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www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

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