Comparative Analysis of 2D vs. 3D Imaging in Diagnosing TMJ Disorders

Differential diagnosis of facial pain and guidelines for management

Temporomandibular disorders comprise a unique group of pathological entities that have complex etiopathogenesis and are extremely difficult to identify early on in the course of the disease even with the sophisticated imaging protocols that are currently available. The clinician is often left with history and clinical findings only before getting a chance to investigate the findings further. It is therefore, quite interesting to see what the current evidence is that has been universally accepted for the diagnosis of temporomandibular joint disorders (TMD). It is fair to say that the research diagnostic criteria for temporomandibular disorders (RDC/TMD) that are universally accepted for the clinical and radiographic diagnosis of TMD use very stringent guidelines for the determination of various disorders that are related to TMD. Ahmad et al. [1] detailed in their paper the criteria for image analysis for diagnosis of TMJ osteoarthritis. They categorized the criteria into three groups- A, B and C. They have grouped those with relatively normal size of the condylar head without any subcortical sclerosis or surface flattening, no known subcortical cystic changes, no surface erosions and no evidence of osteophytosis or generalized sclerosis into group A. Similarly, they have grouped those patients with or without articular flattening, with or without subcortical sclerosis into group B. Finally, only those with clear deformation within the condyles due to subcortical cyst, surface erosions, osteophytosis or generalized sclerosis were classified into the category C. Now, if we ponder further into the rigor with which these are categorized, one would realize quickly that often, the group A or group B category of patients may actually be in the initial phases of TMD where there were no obvious radiographic findings. The clinical picture more frequently reflecting one of the following: myofascial pain, disc related pain, occlusal discrepancy or pain that appears to be neuropathic in origin. In all of these situations, there would be very little morphological changes to the TM joint. How do we then go about diagnosing these TMD patients? Understanding the fundamental mechanisms involved in the liberation of inflammatory byproducts or those that are released in response to pain have changed the way we understand the TMD. Attempts have been made to utilize the biomarkers of inflammation and bone turnover for early diagnosis of various TMDs. Evidence should be gathered to identify all of the byproducts of inflammation, pain and tissue destruction related to the TMJ. At the same time, the evidence should be gathered to make sure that these byproducts that are liberated are very specific to the affliction of TMJ and are uniquely produced as a result of the TMJ-related pathoses. Literature shows that this is the most daunting task in the field of TMD that both basic scientists and clinicians are faced with. Large scale population based studies have isolated the “at-risk” groups for the TMD but the “lack of early diagnostic indicators” have made these studies rather uninteresting. Further, we know that the patients who seek help for TMD are a minority of the larger group of patients who may have the TMD but are not severely symptomatic forcing them seek help. Quite often, the typical TMD patient seeking help is in an advanced form of TMD that is identifiable on radiographs and clinically symptomatic. Although, the subjects with TMD are managed via both conservative and surgical means, the latent period of the disease process remains an enigma. Let us look at the serological or tissue based evidence that we can gather in an attempt to reach an early diagnosis of TMD. The categories that were investigated dealt with either the presence or absence of: Mediators of inflammation such as interleukins (IL) or cytokines Neuropeptides like substance P or calcium gene-related peptide(CGRP) Matrix metallo-proteinases Inhibitors of tissue inflammatory mediators TMJ internal derangements and osteoarthritis are known to be associated with inflammatory processes in the synovial membrane and articular cartilage [2]. The cytokines that are released secondary to the inflammation within the joint such as IL-1, IL-6, TNF-alpha can potentially cause cartilage degradation through upregulation of metalloproteinases gene expression and a decrease in the chondrocyte compensatory synthesis pathways. There are substances that are expressed secondary to nociception like CGRP and substance P have been investigated by various researchers. The TMJ-related structures are mostly covered with fibrous rather than hyaline cartilage unlike the majority of the joints in the body. Fibrocartilage contains mostly type I collagen and the hyaline cartilage contains mostly type II collagen. Type I collagen accounts for over 90 % of organic part of the bone. An increased concentration of CTx-I, the C-terminal cross-linked telepeptides of collagen type I indicates loss of both TMJ fibrocartilage and bone. So, this is not a specific indicator. Similarly, the increased levels of CTx-II can only indicate loss of hyaline cartilage via degenerative or inflammatory changes in the body [3]. This will not help the attempts to diagnose TMD. Hence additional specific tests must be considered. Attempts were made to use pyridinoline and deoxypyridinoline as markers for the diagnosis of TMD. Since these markers are present in the TMJ cartilage and they are not metabolized in the body, their elimination via kidneys would be a good clinical test to determine the degree of TMD. Although the investigators could find a good correlation between the increased levels of Pyr and dPyr in the urine that was detected via high performance liquid Chromatography, no correlation was found to their increased levels and radiographic features suggestive of TMD. Similarly, plasma bradykinin has been investigated to see if the marker is a specific diagnostic marker for TMD [3]. Even though the serum levels correspond to those of synovial fluid levels, it has never been used as a diagnostic or prognostic indicator. We now know that specific information regarding the TMD especially if it is inflammatory in origin can be obtained from biochemical examination of the synovial fluid and that their levels correspond with the joint pain, all three aspects of analysis including bone turnover markers, assessment of inflammatory markers and imaging appear to be the only way one could accurately diagnose either degenerative changes or inflammatory processes affecting the TMJ. Future TMD research should be directed at specific evidence-based mechanisms for both diagnosis and management of TMD.

Objectives: This study examined the changes in temporomandibular joint dysfunction (TMD) symptoms and investigated the variations in the disc position, disc and condylar morphology following sagittal split ramus osteotomy (SSRO) with rigid fixation in patients with mandibular prognathism. Furthermore, the authors examined the correlation between mandibular setback and TMD symptoms.Methods: The study included 24 Japanese patients with jaw deformities who were treated using bilateral SSRO and Le Fort I osteotomy. The clinical and magnetic resonance imaging findings in the temporomandibular joint were evaluated preoperatively and at three and six months postoperatively.Results: The preoperative TMD symptoms were significantly associated with the prevalence of TMD symptoms at six months postoperatively. Anterior disc displacement improved in four joints with slight displacement and with no morphological change. There were no postoperative changes in condylar morphology. There was no significant correlation between mandibular setback and the postoperative TMD symptoms.Conclusion: Postoperative TMD symptoms may be influenced mainly by preoperative TMD symptoms rather than mandibular setback using SSRO with rigid fixation. Therefore, patients with TMD symptoms require physical examination and MRI for appropriate diagnosis preoperatively.

Purpose: To investigate the radiographic characteristics of temporomandibular joint (TMJ) disorders using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI), and to examine the therapeutic effectiveness of intra-articular betamethasone injection in the management of TMJ pathologies. Methods: A total of forty (40) patients diagnosed with suspected TMJ disorders (study group) and 40 healthy volunteers (control group) who underwent comprehensive examinations in the Department of Stomatology and Rehabilitation Medicine, Qiqihar City, Heilongjiang Province, China were enrolled in this study. All participants underwent CBCT and MRI imaging to assess structural characteristics of TMJ, evaluate changes in condylar morphology, presence of disc displacement, and detection of joint effusion. Results: There was no statistically significant difference in image quality between CBCT and MRI modalities (p > 0.05). There was significant difference in posterior joint space, condylar dimensions (internal and external), and anterior/posterior condylar dimensions in both CBCT and MRI assessments between study and control groups (p < 0.05). There was also significant difference in condylar bone morphology using CBCT and MRI scans between the study and control groups (p < 0.05). Furthermore, visual analog scale (VAS) scores of patients in the study group were significantly lower than those of control group (p < 0.05). Conclusion: Magnetic resonance imaging provides superior visualization of the articular disc and surrounding soft tissues, while CBCT offers better delineation of bony structures. Intra-articular betamethasone injection therapy significantly improves efficacy, reduces pain, improves joint function, and increases mouth opening in the management of TMJ disorders. Further studies should include comprehensive outcome measures and assessment tools to provide a more robust evaluation of treatment effects and overall patient well-being.

ObjectiveThis study aimed to investigate the imaging characteristics of temporomandibular joint disorder (TMD) using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI), and to compare their diagnostic performance.MethodsClinical data from 53 TMD patients and 53 healthy controls were retrospectively reviewed. All participants underwent both CBCT and MRI within a two-week interval. Key measurements included condylar dimensions and joint space assessments. The study evaluated each modality’s ability to detect TMD-related abnormalities in the temporomandibular joint (TMJ) and masticatory muscles, such as joint space narrowing, bone changes, disc displacement, and muscle pathology. Statistical analysis compared diagnostic findings between the imaging techniques.ResultsImage quality was comparable between CBCT and MRI (P > 0.05). Both modalities showed no significant differences in superior and anterior joint spaces between TMD and control groups, but the posterior joint space, condylar width, and anteroposterior diameter were significantly different (P < 0.05). Across all participants, significant differences were observed between CBCT and MRI measurements for superior and anterior joint spaces (P < 0.05). Among TMD patients, 69.81% had pain disorders and 30.19% had joint disorders. Both modalities demonstrated high inter- and intra-observer consistency (P < 0.05). CBCT showed high agreement for most bony abnormalities but only moderate for disc and muscle pathology. MRI had high agreement for most findings but was moderate in detecting bone hyperplasia and sclerosis. MRI detected significantly more soft tissue abnormalities, including disc displacement and joint effusion (P < 0.05), while CBCT was more effective in identifying bone hyperplasia, sclerosis, and condylar deformation (P < 0.05).ConclusionBoth CBCT and MRI are highly valuable tools for differentiating and assessing TMD. CBCT excels in evaluating bone-related changes, whereas MRI is superior for assessing the articular disc and soft tissue abnormalities.

Introduction. Temporomandibular joint (TMJ) dysfunction is the second most common musculoskeletal disease, affecting up to 33 % of people during their lifetime. The multicomponent etiopathogenesis of the disease actualizes the use of diagnostic criteria for the early symptoms of developing functional disorders. The algorithm for preclinical examination of the TMJ must be used already in the dentist′s office, which will allow to avoid the unpredictable results of dental rehabilitation and in time to attract other specialists to the complex therapy of the patient. The etiopathogenesis of TMJ dysfunction indicates the need for a closer study of the mutual infl uence of structural imbalances in the body and dentition, the determination of the primary disorder, which will help to develop a system for the prevention of TMJ dysfunctions, and may also affect the sequence, volume and nature of the treatment for this pathology.The goal of research — to identify the relationship of structural imbalances in the body and temporomandibular joint dysfunction.Materials and methods. From September to December 2019, a prospective study of 70 volunteers among university students was conducted at the Department of Orthopedic Dentistry of Omsk State Medical University. During the processing of clinical material, 6 people retired in accordance with exclusion criteria. All subjects underwent an assessment of the state of the dentofacial system, primarily the TMJ (using a short Hamburg test) and structural imbalances of the body (using the Notch Interfaces Inc. motion capture and reconstruction system). To assess the cervical-cranial relationship in the subjects who had 3–6 points according to the results of the Hamburg test, a head X-ray was make in lateral projection, and cephalometric analyzes were performed according to Rocabado and Sassuni. The presence and strength of the linear relationship between the phenomena was determined using the Pearson coefficient.Results. According to the results of the Hamburg test, a functional norm was revealed in only 12,5 % of the examined; TMJ dysfunction was revealed in the vast majority of volunteers (57,9 %). Structural imbalances of the body were detected in 82,8 % of cases. Patients with established by the results of the Hamburg test TMJ dysfunction were underwent cephalometric analysis. Structural changes in the TMJ were not found in the subjects according to the X-ray studies results. There was a high positive relationship between functional TMJ dysfunction and pelvic hyperfl exion (ρ=0,72, p&lt;0,05), and an average positive relationship (ρ=0,55, p&lt;0,05) between the head and neck forward tilting. A positive weak relationship was observed between the risk of TMJ dysfunction developing (2 points according to the Hamburg test) and pelvic hyperfl exion (ρ=0,31, p&lt;0,05).Conclusion. The study showed a strong positive relationship between pelvic hyperfl exion and TMJ dysfunction signs; an average positive relationship between TMJ functional impairment and head and neck forward tilting. It was also found that in individuals with TMJ dysfunction signs there were no radiological signs of structural changes in the joint, which indicates the potential reversibility of the revealed disorders and the need for their timely detection and correction. This study is pilot and will be continued in a broader format.

This study investigated the usefulness of quantitative parameters [longitudinal relaxation (T1), transverse relaxation (T2), and proton density (PD)] obtained with synthetic magnetic resonance imaging (MRI) in assessing the progression of temporomandibular joint (TMJ) disorders. For individual TMJ disorder diagnoses, the presence of disc displacement in MRI and the osseous change in cone-beam CT were investigated. Joints were classified into three stages: (1) silent stage, no disc displacement or osseous change; (2) incipient stage, presence of disc displacement and absence of osseous change; and (3) progressed stage, both disc displacement and osseous change. In synthetic MRI, the T1, T2, and PD values of the condyle bone marrow were measured simultaneously. The median T1, T2, and PD values were analyzed according to disc displacement, osseous changes, and joint stage. Significant differences were observed in the T1 and PD values of joints with disc displacement or condylar osseous change compared to normal joints. The T1 and PD values also differed between the silent and progressed stages. The PD value differed between the silent and incipient groups, while the T2 value did not differ significantly among the three groups. The PD and T1 values of condylar bone marrow obtained from synthetic MRI can be used as sensitive indicators of TMJ disorder progression. The PD value of the bone marrow showed potential as a useful biomarker for recognizing the initial stages of TMJ disorders. Synthetic MRI is useful for the simultaneous acquisition of effective MRI parameters for evaluating TMJ disorders.

Subject. Questions of diagnostics and revealing of the reasons of temporo-mandibular joint (TMJ) disorders are very significant now. Realities of modern stomatology have a significant impact, namely, use of materials with high durability and rigidity, widely available of total restorations and orthodontic treatment, insufficiency of the high-grade diagnostics of maxillofacial pathology for revealing latent, compensated TMJ disorders before stomatologic intervention. All these factors leads to occurrence of patients with the expressed, developed semiology. The purpose. To consider interrelation of various occlusion derangements, lateral displacement of the mandible and internal TMJ disorders (or dislocations of the TMJ disc, intraarticulate elements). Methodology. The estimation of frequency of occurrence of TMJ disc dislocations according to literary sources is carried out, various etiological factors of internal TMJ disorders are considered, in particular, some types of pathological occlusion, which may have an essential impact on the violation of the ratio of intraarticulate elements. Two clinical cases of patients with TMJ disorders with similar semiology and presence of transversal malocclusion due to improper jaws growth and presence of the acquired pathology as result of stomatologic intervention as an example. Results of research. According to the domestic and foreign literature the role of occlusion factors in development of TMJ disorders is represents approximately 10―20 %, however there are researches by types of occlusal disorders which almost always lead to those or other TMJ disorders. Conclusion. It is revealed, that transversal malocclusion most often provokes TMJ dysfunction and internal joint disorders. In the future it is planned to reveal occlusal factors which able to provoke the development of TMJ disorders with high probability, mechanism of their influence and methods of revealing.

The incidence of temporomandibular joint dysfunction in women reaches 80% of the total number of patients. The symptoms of temporomandibular joint dysfunction are varied and were first described by otorhinolaryngologist J.B. Costen. In his honor, the entire symptom complex of this disease is named "Costen's syndrome" in specialized literature and in the International Classification of Diseases of the tenth revision. The symptom complex includes joint pain, sometimes radiating to the neck, back of the head, temple, ear, clicks in the joint during movements of the lower jaw, trismus, hearing loss, dull pain in the middle and outside the ear, pain and burning sensation of the tongue, dry mouth; dizziness, pain on the side of the affected joint and even facial pains like trigeminal neuralgia. It is clinically difficult to isolate all these symptoms in patients with dysfunction of the temporomandibular joint, because its pathogenic and etiological manifestation is characterized in most cases only by one or several symptoms.&#x0D; Temporomandibular joint dysfunction is polyetiological, has a varied clinical picture and is directly dependent on the hormonal state, and especially the gynecological status. Much attention is drawn to the study of estrogen, which, in addition to regulating the functioning of the reproductive system in a woman's body, also performs a number of other important functions, including helping the joint to remain healthy - preventing calcium leaching, stimulating collagen recovery and the work of osteoblasts.&#x0D; The aim of the study was to determine the frequency of temporomandibular joint dysfunction in women along with hormonal changes and to trace their correlation.&#x0D; Materials and methods. The study involved 169 students of the third year at the Department of Propedeutics of Surgical Dentistry of the Faculty of Dentistry of the Ukrainian Medical Stomatological Academy. The research methods were based on conducting an anonymous survey. The questions were written for both men and women and were characterized by general dental status. Questions on gynecological status were asked separately for women.&#x0D; Results and discussion. The study group consisted of 169 people, including 89 women and 80 men aged 18 to 28 years. 61% of men and 26% of women did not have complicated dental status, among those surveyed. At the same time, 35% of men (of their total number) and 28% of women (of their total number) had orthodontic pathology. The presence of individual symptoms of temporomandibular joint dysfunction in men was observed in 6% of the total number of patients, in women - 19% (4% of them had already consulted a dentist, but did not receive adequate treatment). It is worth noting that patients with suspected temporomandibular joint pathology complained only of clicks when opening their mouths or chewing.&#x0D; Among 89 women studied, 8% had temporomandibular joint dysfunction, but did not have pathologies of the reproductive system. In 20% of women who did not have temporomandibular joint dysfunction, pathology of the reproductive system was noted. 11% had temporomandibular joint dysfunction and pathology of the reproductive system. 26% of women were clinically healthy.&#x0D; Out of 10 women with temporomandibular joint dysfunction who had a pathology of the reproductive system, but never had problems with the dentition, 10% of the women in the group (1% of all women examined) suffered from menstrual irregularities and had human papillomavirus in their anamnesis. 20% had a suspicion of temporomandibular joint pathology along with problems in their gynecological status and a history of orthodontic treatment, 10% had menstrual irregularities (algodismenorrhea) and were treated by a gynecologist with hormonal contraceptives for up to 1.5 years. 30% of women had temporomandibular joint pathology with problems in their gynecological status and previous therapeutic treatment (presence of fillings in the oral cavity). Of these, 20% have menstrual irregularities, and 10% have cervical erosion. 40% of the total number of women had temporomandibular joint pathology with orthodontic treatment in the past and fillings in the oral cavity along with problems in their gynecological status, where all had menstrual irregularities. 10% of them had metaplasia, erosion of the cervix and uterine polyp, 10% - erosion of the cervix.&#x0D; It should be noted that out of 89 women, 14 (17.5%) did not have any complaints about the condition of the joint, but had fillings and orthodontic treatment in the past, as well as pathology of the reproductive system. 11 of them (14%) had menstrual irregularities. In 3 (4%) patients out of the total number of women, there was an increased level of androgens, progesterone, estradiol and a history of treatment by a gynecologist.&#x0D; Based on the results obtained, it is possible to confirm the forced frequency of women visiting the dentist. Among the total number of women with temporomandibular joint dysfunction and pathology of the reproductive system, there was only 1 patient out of 89 persons without any dental interventions in the past. This does not give us a reason to associate gynecological status with the etiology of temporomandibular joint dysfunction. But in view of the greater prevalence of temporomandibular joint dysfunction along with gynecological pathologies, it gives us a basis for active further research on this topic.

Background: The controversy surrounding the role of occlusion in temporomandibular joint (TMJ) dysfunction led to this study. Temporomandibular joint (TMJ) dysfunction has been the subject of considerable study for decades, yet despite voluminous literature, the multifactorial aetiology of temporomandibular dysfunction, is even today a cryptic issue.The cause of the signs and symptoms of TMJ dysfunction is not clearly understood and various opinions on their aetiology have been offered. The aim of study was to evaluate the effects of the occlusal interference with fixed prosthesis on the position of the terminal hinge axis and to stady the role of the occlusal interference with fixed prosthesis in the etiology of Temporomandibular joint dysfunction by using cadiax compact 2. Material and methods this study was carried out on 32 patients who came to the teaching hospital in the college of dentistry at university of al Mustansiria suffering from missing teeth and need for substitution by fixed partial denture. Everyone of the selected sample was examined in three visits with a new computerized axiography technology for recording the transverse hinge axis and Bennett movement by cadiax compact 2 and an evaluation for TMD was done by Helkimo index which was used to collect the TMJ dysfunction data, The 1st record in the 1st visit at the starting date before dental preparation, the 2nd record immediately after cementation of fixed prosthesis and the 3rd recorded 1 month after the 2nd record. Result: The results of this study showed that no effect of occlusion adjustment on TMD by using fixed partial denture even if patients have change in position of hinge axis and Bennett angle .the comparison between the angle changes in the same side of treatment shows no significant changes (p value >0.05) and that is shown also by Helkimo index because there was no score for all the patients. Conclusion Occlusion interferance does not play a major role in the aetiology of TMD; the impact of occlusion is not zero, however, and should be determined in each individual case.

Temporomandibular joint (TMJ) disorders (TMD) are usually diagnosed based on the patient's clinical findings and the results of image investigations; however, understanding of the inflammatory process in TMJ is difficult. In addition, many of the TMJ disease types share common principal symptoms. Therefore, TMJ diseases in the early stage can be misdiagnosed with TMD. It is hypothesized that cytopathologic examination of the joint lavage fluids is useful in interpreting the TMD-associated inflammatory process from a cellular aspect. The aim of this study was to assess the TMJ lavage fluid cytopathologically in TMD patients. Thirty-nine patients, clinically diagnosed as TMD, were included in the present study. Clinical symptoms of the patients were recorded. Forty-four samples of TMJ lavage fluid were collected and paraffin-embedded cell sections were made by cell block tissue array method. Cytologic conditions in upper articular cavity of TMJ were cytopathologically diagnosed and were compared with the clinical symptoms of each patient. Cell components were detected in 22 of the 44 analyzed joint lavage fluids. There was a correlation between cytopathologic findings and clinical symptoms. Variety of cytopathology and inflammatory conditions in patients with similar clinical symptoms were also found. The results suggested that cytopathologic examination of the joint lavage fluids from TMD patients is helpful for gaining an understanding of the inner local conditions of TMJ at the cellular level.

Background: To assess the prevalence of the symptoms and signs of temporomandibular disorders (TMDs) and determine the prevalence of TMDs among elderly Vietnamese aged 65–74 years old. Methods: A cross-sectional study was conducted among 258 participants aged 65–74 years old (128 females and 130 males) using two strategies for TMD diagnosis: a clinical examination of the temporomandibular joint and its associated structures using the Diagnostic Criteria for Temporomandibular Disorders Axis I; and a set of 14 questions regarding TMD symptoms to obtain anamnestic data. Results: The prevalence of TMD symptoms was: headache 49.6%; temporomandibular joint noise 28.0%; orofacial pain 25.2%; jaw locking 3.1%; 62.5% of participants had at least one TMD symptom. Headaches were more prevalent in females than males ( p=0.009) and rural than urban residents ( p&lt;0.001). The most frequent signs were temporomandibular joint crepitus (50.4%), clicking (48.1%) and mouth-opening deviation (37.6%). Temporomandibular joint crepitus and mouth-opening deviation were more frequent among rural than urban ( p=0.024 and p&lt;0.001, respectively). TMD was found in 56.6% of the total sample. Of the TMD sufferers, 37.6% were diagnosed with disc displacement, 34.9% with degenerative joint disease, 3.5% with myalgia and 1.2% with arthralgia. Conclusions: More than half of elderly Vietnamese have at least one TMD symptom. TMD sounds were the most common clinical sign of TMD. There were no differences between the genders or place of residence and TMD diagnosis. Disc displacement and degenerative joint disease were most prevalent among elderly Vietnamese.

Purpose To evaluate the diagnostic accuracy of the quantitative parameter standardized uptake value (SUV) at single photon emission computed tomography (SPECT)/computed tomography (CT) for the evaluation of temporomandibular joint (TMJ) disorder (TMD). Materials and Methods This study was approved by the institutional review board, and the need for informed consent was waived. Forty-four TMJs in 22 patients with TMD (five men and 17 women; mean age ± standard deviation, 30.0 years ± 12.1) were evaluated. The patients underwent planar bone scintigraphy and SPECT/CT 3-4 hours after injection of technetium 99m hydroxymethylene diphosphonate. The planar scintigraphy parameter of relative ratio (RR) and SPECT/CT parameters mean SUV (SUVmean) and maximum SUV (SUVmax) were compared for the visual assessment of TMD on planar scintigraphy images and for the presence of TMJ arthralgia. Group comparisons, receiver operating characteristic analysis, and Pearson correlation analysis were conducted. Results SUVmax gradually increased from normal (2.82 ± 0.73) to mild or moderately abnormal (3.56 ± 0.76, P < .05) and then to severely abnormal (4.86 ± 1.25, P < .05). However, RR and SUVmean did not vary significantly according to visual grade (P > .05). On the other hand, SUVmax was significantly greater in arthralgic TMJs (4.15 ± 1.11) than in nonarthralgic TMJs (2.97 ± 0.75, P < .001), as was SUVmean (1.63 ± 0.42 vs 1.30 ± 0.31, respectively; P = .005). However, there was no significant difference in RR (3.61 ± 0.57 vs 3.76 ± 0.68, P = .45). In receiver operating characteristic curve analyses for arthralgic TMJ, SUVmax had the greatest area under the curve (area of 0.815). Conclusion SUVmax derived from bone SPECT/CT may be useful for the evaluation of TMD. (©) RSNA, 2016 Online supplemental material is available for this article.

Arthroscopic laser surgery for temporomandibular joint disorders

AimThe first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes “splint therapy” and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD.Materials and Methods:We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance.Results:One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1–9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex, severity of symptoms and duration of the treatment did not influence treatment results in this group of patients with early TMD.Conclusion:In this population, TMD was significantly higher in females. Treatment of early TMD with IOS was effective and moderately effective in long-term in over 80% of the patients during the follow-up period of 1–9 years. Bruxism had a significant etiologic role in TMD; occlusal attrition of the dentition, pain of all the teeth, early morning pain of the masticatory muscles and the TMJ are signs and symptoms to suspect nocturnal bruxism. Use of an IOS is recommended to prevent potential damage to the dentition, periodontium and the TMJ in early TMD.