Evaluation of TMJ by conventional transcranial radiography and indirect digitized images to determine condylar position in primary dentition

The aim of this study was to evaluate temporomandibular joint radiographs of children in primary dentition,

obtained by conventional transcranial radiography, indirect digitization, digitized images using 3D

and brightness/contrast tools. Condyle position was also determined measuring anterior, superior and posterior

joint space. The X-Ray machine GE-1000 and the head positioner Accurad 200 were used. Radiographs

were digitized using a scanner with transparency and registered in Adobe Photoshop 5.0. Images

were evaluated by four examiners as follows: 0 – unacceptably quality; 1 – poorly diagnostic quality;

2 – optimal visualization quality. Articular space was measured using a digital caliper.A significant difference

(Sign Test) was found between conventional radiography and the remaining modalities (Conventional/

Unenhanced p<0.001; Conventional/3D p<0.001; Conventional/Brightness and Contrast p=0.017).

The mean distance of anterior, superior and posterior regions was 2.2(0.5, 3.5(0.9 and 3.9(1.2mm, respectively.

Conventional and brightness/contrast digitized radiographs showed higher diagnostic quality. The

posterior joint space was larger than the anterior one, demonstrating anterior condylar position.

1. Piette E. Anatomy of the human temporomandibular joint. An updated comprehensive review.Acta Stomatol Belg 90:103-127,1993.

2. Larheim TA. Current trends in temporomandibular joint imag-ing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 80: 555-576, 1995.

3. Mohl ND, Dixon C. Current status of diagnostic procedures for temporomandibular disorders. J Am Dent Assoc 125: 56-64, 1994.

4. Borg E, Gröndahl HG. On the dynamic range of different X-ray photon detectors in intra-oral radiography. A comparison of image quality in film, charged-coupled device and storage phos-phor systems. Dentomaxillofac Radiol 25: 82-88, 1996.

5. Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG, Omnell A 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 83: 609-618, 1997.

6. Pharoah MJ. The prescription of diagnotic images for temporo-mandibular joint disorders. J Orofac Pain 13: 251-254, 1999.

7. Epstein JB, Caldwell J, Black G. The utility of panoramic imaging of the temporomandibular joint in patients with temporo-mandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92: 236-239, 2001.

8. Trapnell CJ, Scarfe WC, Cook JH, Silvejra AM, Regennitter FJ, Haskell BS. Diagnostic accuracy of film-based, TIFF and wavelet compressed digital temporomandibular joint images. J Digit Imaging 13: 38-45, 2000.

9. Held CL, Ferguson DJ, Gallo MW. Cephalometric digitization: A determination of the minimum sacanner settings necessary for precise landmark identification. Am J Orthod Dentofacial Orthop 119: 472-481, 2001.

10. Versteeg CH, Sanderink GCH, Van Der Stelt, PF. Efficacy of digital intra-oral radiography in clinical dentistry. J Dent 25: 215- 224, 1997.

11. Gynther GW, Tronje G. Comparison of arthroscopy and radi-ography in patients with temporomandibular joint symptoms and generalized arthritis. Dentomaxillofac Radiol 27: 107-112, 1998.

12. Kapa SL, Tyndall DA, Zullo TG, Bagnell CR. Assessing condylar changes with digital subtraction radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 75: 247-252, 1993.

13. Sanchez-Woodworth RE, Katzberg RW, Tallents RH, Guay JA. Radiographic assessment of temporomandibular joint pain and dysfunction in the pediatric age-group. ASDC J Dent Child 55: 278- 281, 1988.

14. Madsen B. Normal variations in anatomy, condylar movements and arthrosis frequency of the temporomandibular joints. Acta Radiol 4: 273-288, 1966.

15. Oberg T, Carlson G, Frajers CC. The temporomandibular joint: a morphological study on human autopsy material.Acta Odontol Scand 29: 349-384, 1971.

16. Goldstein H, Bloom C. Detection of degenerative disease of the temporomandibular joint by bone scientigraphy: Concise communication. J Nucl Med 21: 928-930, 1980.

17. Fricton JR, Pullinger AG, Mohl ND. Postdoctoral education for TMD and orofacial pain: a philosophical overview. J Craniomand Disord Fac Oral Pain 6: 123-125, 1992.

18. Wenzel A. Influence of computerized information technologies on image quality in dental radiographs. Tandlaegebladet 95: 527- 559, 1991.

19. Pullinger A. The significance of condyle position in normal and abnormal temporomandibular joint function. In: Perspectives in temporomandibular disorders. Clark GT, Soberg W, editors (ed. Quintessence), pp. 89-103. Chicago, 1987.

20. Pullinger AG, Hollender L, Solberg WK, Petersson A. A tomo-graphic study of mandibular condyle position in an asympto-matic population. J Prosthetic Dent 53: 706-713, 1985.

21. Ekberg EC, Peterson A, Nilner M. An evaluation of digital sub-traction radiography for assessment of changes in position of the mandibular condyle. Dentomaxillofac Radiol 27: 230-235, 1998.

22. Weinberg LA.An evaluation of duplicability of temporomandibu-lar joint radiographs. J Prosthetic Dent 24: 512-539, 1970.

23. Preti G, Scotti R, Turbiglio G, Scala C. Anatomic study of condi-lar position at maximum intercuspidation. J Prosthetic Dent 47: 445- 448, 1982.

24. Pullinger A, Hollender L. Assessment of mandibular condyle position: A comparison of transcranial radiographs and linear tomograms. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 60: 329-334, 1985.

25. Zhou D, Hu M, Liang D, Zhao G, Liu A. Relationship between fossa-condylar position, meniscus position, and morphologic change in patients with Class II and III malocclusion. Chin J Dent Res 2: 45-49, 1999.

26. Lam PH, Sadowsky C, Omerza F. Mandibular asymmetry and condylar position in children with unilateral posterior crossbite. Am J Orthod Dentofacial Orthop 115: 569-575, 1999.

27. Myers DR., Barenie JT, Bell RA, Williamson EH. Condylar position in children with functional posterior crossbites: before and after crossbite correction. Pediatr Dent 2: 190-194, 1980.