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Cephalometric Characteristics of TMD Patients based on RDC/TMD Axis I Diagnosis

RDC/TMD Axis I 진단에 따른 측두하악장애 환자의 측두 두부방사선적 특징에 관한 연구

  • Ahn, Ji-Yeon (Dept. of Oral Medicine and Oral Diagnosis, School of Dentistry & Dental Research Institute, Seoul National University) ;
  • Kim, Yong-Woo (Dept. of Oral Medicine and Oral Diagnosis, School of Dentistry & Dental Research Institute, Seoul National University) ;
  • Kim, Young-Ku (Dept. of Oral Medicine and Oral Diagnosis, School of Dentistry & Dental Research Institute, Seoul National University) ;
  • Lee, Jeong-Yun (Dept. of Oral Medicine and Oral Diagnosis, School of Dentistry & Dental Research Institute, Seoul National University)
  • 안지연 (서울대학교 치의학대학원 구강내과진단학 교실, 치의학연구소) ;
  • 김용우 (서울대학교 치의학대학원 구강내과진단학 교실, 치의학연구소) ;
  • 김영구 (서울대학교 치의학대학원 구강내과진단학 교실, 치의학연구소) ;
  • 이정윤 (서울대학교 치의학대학원 구강내과진단학 교실, 치의학연구소)
  • Received : 2011.02.17
  • Accepted : 2011.03.10
  • Published : 2011.03.30

Abstract

The aims of this study were to investigate whether the facial skeletal patterns previously reported to be related to temporomandibular disorder (TMD) in other studies could be consistently observed in the TMD patients diagnosed according to Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) Axis I and evaluate its usability in the orthodontic clinics to examine the patients with TMD related symptoms. The clinical records and radiographs of female patients who visited the TMD and Orofacial Pain Clinic of Seoul National University Dental Hospital and were diagnosed as TMD were consecutively filed for this study. Patients were clinically examined and diagnosed according to the revised diagnostic algorithms of RDC/TMD Axis I and the lateral cephalogram, panoramic orthopantomogram, temporomandibular joint (TMJ) orthopantomogram, and transcranial radiograph of each patient were taken and digitalized. The data of patients who were under 18 years of age or had any systemic disease, trauma history involving the TMJ, or skeletal deformity at the time of the first examination were excluded. The remaining data of 96 female patients were finally analyzed. The obtained results were as follows: 1. There are no significant differences of cephalometric measurements between RDC I (muscle disorders) diagnostic groups. 2. Only the articular angle of the RDC group IIc (disk displacement without reduction without limited opening) patients was larger than patients of the no diagnosis of RDC II group (disk displacement). 3. Larger articular angle and smaller facial height ratio were observed in RDC IIIc group (osteoarthrosis) compared to IIIa group (arthralgia). Larger articular angle, larger Bjork sum, smaller posterior facial height, and smaller facial height ratio were observed in RDC group IIIc compared to no diagnosis of RDC III group (arthralgia, arthritis, and arthrosis). 4. According to the results of cephalometric analysis in simplified RDC groups, smaller overjet was observed in muscle disorders (MD) group. Facial height ratio and IMPA were smaller and articular angle was larger in disk displacements (DD) group than in no diagnosis of DD group. In arthrosis (AR) group, posterior facial height, and facial height ratio were smaller, and articular angle, gonial angle, facial convexity, FMA, Bjork sum, and ANB were larger than in no diagnosis of AR group. In joint pain (JP) group, only posterior facial height was smaller than no diagnosis of JP group. In conclusion, Facial morphologic patterns showing posterior-rotated mandible and lower posterior facial height is related to RDC group II and III diagnosis of the TMJ in female TMD patients. RDC/TMD Axis I diagnosis can provide a good clinical diagnostic tool for the standardized examination of the TMJ in orthodontic clinics.

References

  1. Nebbe B, Major PW, Prasad NG. Adolescent female craniofacial morphology associated with advanced bilateral TMJ disc displacement. Eur J Orthod. 1998;20:701-712. https://doi.org/10.1093/ejo/20.6.701
  2. Nebbe B, Major PW, Prasad N. Female adolescent facial pattern associated with TMJ disk displacement and reduction in disk length: part I. Am J Orthod Dentofacial Orthop. 1999;116:168-176. https://doi.org/10.1016/S0889-5406(99)70214-3
  3. Gidarakou IK, Tallents RH, Kyrkanides S, Stein S, Moss ME. Comparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with bilateral disk displacement with reduction. Angle Orthod. 2002;72:541-546.
  4. Gidarakou IK, Tallents RH, Kyrkanides S, Stein S, Moss M. Comparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with bilateral degenerative joint disease. Angle Orthod. 2003;73:71-78.
  5. Gidarakou IK, Tallents RH, Kyrkanides S, Stein S, Moss ME. Comparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with normal temporomandibular joints. Angle Orthod. 2003;73:116-120.
  6. Gidarakou IK, Tallents RH, Kyrkanides S, Stein S, Moss ME. Comparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with unilateral disk displacement without reduction. Angle Orthod. 2003; 73:121-127.
  7. Gidarakou IK, Tallents RH, Stein S, Kyrkanides S, Moss ME. Comparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with unilateral disk displacement with reduction. Angle Orthod. 2004;74: 212-219.
  8. Gidarakou IK, Tallents RH, Kyrkanides S, Stein S, Moss ME. Comparison of skeletal and dental morphology in asymptomatic volunteers and symptomatic patients with bilateral disk displacement without reduction. Angle Orthod. 2004;74:684-690.
  9. Byun ES, Ahn SJ, Kim TW. Relationship between internal derangement of the temporomandibular joint and dentofacial morphology in women with anterior open bite. Am J Orthod Dentofacial Orthop. 2005 Jul;128:87-95.
  10. Ioi H, Matsumoto R, Nishioka M, Goto TK, Nakata S, Nakasima A, Counts AL. Relationship of TMJ osteoarthritis / osteoarthrosis to head posture and dentofacial morphology. Orthod Craniofac Res. 2008;11:8-16. https://doi.org/10.1111/j.1601-6343.2008.00406.x
  11. Hwang CJ, Sung SJ, Kim SJ. Lateral cephalometric characteristics of malocclusion patients with temporomandibular joint disorder symptoms. Am J Orthod Dentofacial Orthop. 2006;129:497-503. https://doi.org/10.1016/j.ajodo.2004.12.019
  12. Ahn SJ, Kim TW, Nahm DS. Cephalometric keys to internal derangement of temporomandibular joint in women with Class II malocclusions. Am J Orthod Dentofacial Orthop. 2004;126:486-495.
  13. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6:301-355.
  14. Goulet JP, Lavigne GJ, Lund JP. Jaw pain prevalence among French-speaking Canadians in Qubec and related symptoms of temporomandibular disorders. J Dent Res. 1995;74:1738-1744. https://doi.org/10.1177/00220345950740110401
  15. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. J Orofac Pain. 1996;10:240-253.
  16. Lobbezoo-Scholte AM, De Leeuw JR, Steenks MH, Bosman F, Buchner R, Olthoff LW. Diagnostic subgroups of craniomandibular disorders. Part I: Self-report data and clinical findings. J Orofac Pain. 1995;9:24-36.
  17. Look JO, Schiffman EL, Truelove EL, Ahmad M. Reliability and validity of axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) with proposed revisions. J Oral Rehabil. 2010;37:744-759. https://doi.org/10.1111/j.1365-2842.2010.02121.x
  18. Schiffman EL, Ohrbach R, Truelove EL, Tai F, Anderson GC, Pan W, Gonzalez YM, John MT, Sommers E, List T, Velly AM, Kang W, Look JO. The Research Diagnostic Criteria for Temporomandibular Disorders. V: methods used to establish and validate revised Axis I diagnostic algorithms. J Orofac Pain. 2010;24:63-78.
  19. Grummons D. Orthodontics for the TMJ-TMD Patient. Wright and Co. 1994.
  20. Bell DE, Harris EF. Disclusion in mandibular protrusion. Angle Orthod. 1983;53:146-156.
  21. Ahn SJ, Baek SH, Kim TW, Nahm DS. Discrimination of internal derangement of temporomandibular joint by lateral cephalometric analysis. Am J Orthod Dentofacial Orthop. 2006;130:331-339 https://doi.org/10.1016/j.ajodo.2005.02.019
  22. Bsio JA, Burch JG, Tallents RH, Wade DB, Beck FM. Lateral cephalometric analysis of asymptomatic volunteers and symptomatic patients with and without bilateral temporomandibular joint disk displacement. Am J Orthod Dentofacial Orthop. 1998;114:248-255. https://doi.org/10.1016/S0889-5406(98)70206-9
  23. Roth RH. Temporomandibular pain-dysfunction and occlusal relationships. Angle Orthod. 1973;43:136-153.
  24. Dibbets JM, van der Weele LT, Uildriks AK. Symptoms of TMJ dysfunction: indicators of growth patterns? J Pedod. 1985;9:265-284.
  25. Dibbets JM, Carlson DS. Implications of temporomandibular disorders for facial growth and orthodontic treatment. Semin Orthod. 1995;1:258-272. https://doi.org/10.1016/S1073-8746(95)80056-5
  26. Tanaka E, Detamore MS, Mercuri LG. Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment. J Dent Res. 2008;87: 296-307. https://doi.org/10.1177/154405910808700406
  27. Link JJ, Nickerson JW Jr. Temporomandibular joint internal derangements in an orthognathic surgery population. Int J Adult Orthodon Orthognath Surg. 1992;7:161-169.
  28. Trpkova B, Major P, Nebbe B, Prasad N. Craniofacial asymmetry and temporomandibular joint internal derangement in female adolescents: a posteroanterior cephalometric study. Angle Orthod. 2000;70:81-88.
  29. Schellhas KP, Pollei SR, Wilkes CH. Pediatric internal derangements of the temporomandibular joint: effect on facial development. Am J Orthod Dentofacial Orthop. 1993;104:51-59. https://doi.org/10.1016/0889-5406(93)70027-L
  30. Schellhas KP, Piper MA, Omlie MR. Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients. AJNR Am J Neuroradiol. 1990;11:541-551.
  31. Stewart A, Harris M. Acquired anterior open bite and facial arthromyalgia: possible aetiology. Br J Oral Maxillofac Surg. 1996;34:174-180. https://doi.org/10.1016/S0266-4356(96)90373-3
  32. Hall HD. Intra-articular disc displacement Part II: Its significant role in temporomandibular joint pathology. J Oral Maxillofac Surg. 1995;53:1073-1079. https://doi.org/10.1016/0278-2391(95)90127-2
  33. Westesson PL, Eriksson L, Kurita K. Reliability of a negative clinical temporomandibular joint examination: prevalence of disk displacement in asymptomatic temporomandibular joints. Oral Surg Oral Med Oral Pathol. 1989;68:551-554. https://doi.org/10.1016/0030-4220(89)90236-3
  34. Tallents RH, Hatala M, Katzberg RW, Westesson PL. Temporomandibular joint sounds in asymptomatic volunteers. J Prosthet Dent. 1993;69:298-304. https://doi.org/10.1016/0022-3913(93)90110-A
  35. Tallents RH, Katzberg RW, Murphy W, Proskin H. Magnetic resonance imaging findings in asymptomatic volunteers and symptomatic patients with temporomandibular disorders. J Prosthet Dent. 1996;75:529-533. https://doi.org/10.1016/S0022-3913(96)90458-8
  36. Ribeiro RF, Tallents RH, Katzberg RW, Murphy WC, Moss ME, Magalhaes AC, Tavano O. The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years. J Orofac Pain. 1997;11:37-47.
  37. Morrow D, Tallents RH, Katzberg RW, Murphy WC, Hart TC. Relationship of other joint problems and anterior disc position in symptomatic TMD patients and in asymptomatic volunteers. J Orofac Pain. 1996;10:15-20.
  38. Axelsson S. Human and experimental osteoarthrosis of the temporomandibular joint. Morphological and biochemical studies. Swed Dent J Suppl. 1993;92:1-45.
  39. 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: 416-425. https://doi.org/10.1016/0030-4220(94)90031-0
  40. 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;32:69-81.
  41. Westesson PL, Rohlin M. Internal derangement related to osteoarthrosis in temporomandibular joint autopsy specimens. Oral Surg Oral Med Oral Pathol. 1984;57:17-22. https://doi.org/10.1016/0030-4220(84)90251-2
  42. Roberts CA, Katzberg RW, Tallents RH, Espeland MA, Handelman SL. Correlation of clinical parameters to the arthrographic depiction of temporomandibular joint internal derangements. Oral Surg Oral Med Oral Pathol. 1988;66:32-36. https://doi.org/10.1016/0030-4220(88)90062-X
  43. Campos PS, Cangussu MC, Guimares 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;37:529-534. https://doi.org/10.1016/j.ijom.2008.02.011
  44. Michelotti A, Iodice G. The role of orthodontics in temporomandibular disorders. J Oral Rehabil. 2010;37:411-429. https://doi.org/10.1111/j.1365-2842.2010.02087.x