• Journal of Oral Medicine and Pain
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• 제42권2호
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• pp.35-43
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• 2017

Purpose: This study aims to evaluate the correlation between joint sounds and radiographic bone change patterns along with clinical symptoms of temporomandibular joint osteoarthritis (TMJ OA) patients. Methods: The patients for this study were over 19 years of age, diagnosed tentatively with TMJ OA. The patients were examined with temporomandibular disorders analysis test and all three radiographs, including panoramic radiography, transcranial radiography, and cone beam computed tomography (CBCT). Information of the patients' age, pain status, joint sound and mouth opening range were collected. And bone change pattern was examined by reviewing panoramic radiography, transcranial radiography and CBCT images. Results: The patients with crepitus had a higher average active mouth opening (AMO) range than patients without crepitus, and the group with bilateral crepitus had a higher average AMO range than the group with unilateral crepitus (p<0.001). And the patient with pain during mastication was increased in the group with clicking than the group without clicking, and the group with bilateral clicking showed a statistically significant increase in the patient with pain during mastication than the group with unilateral clicking (p<0.05). The analytical results of the relevance of crepitus showed a high correlation with bone change observed from each of the three radiographs. And the agreement in bone change findings from 3 groups of paired radiographs showed high agreement (p<0.001). Meanwhile, 77.2% of CBCT findings showed bone change of condyle without crepitus (p<0.001). Conclusions: This study presented significant results in the evaluation of the correlation with crepitus and bone change of TMJ OA patients from panoramic radiography or transcranial projection. However, the accurate assessment is required through CBCT for the patient with complains of persistent pain, limitation of mouth opening, and occlusal change even if the crepitus does not exist.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권3호
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• pp.294-300
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• 2000

Purpose: The aim of this study was to find the clinical characteristics of the patients who had temporomandibular joint internal derangement(ID) with disc adhesion(adhesion group) compared to only disc displacement without disc adhesion, perforation, hyperemia, and so on(ID group). Materials and methods: Thirty seven joints were included in adhesion group and 54 joints in ID group of all 174 patients(174 joints) treated surgically and had been checked periodically over 12 months at TMJ clinic of Yongdong Severance Hospital, Yonsei University, between 1992 and 1997. Mouth opening range, pain during mouth opening and biting, headache, neck/shoulder pain and TMJ sound were checked his/her every visit before and after surgery. Results: The maximum mouth opening was improved significantly after postoperative 3 months in two groups(p<0.01), but adhesion group was less improved. Pain during mouth opening was improved significantly over 3 months after surgery in adhesion group(p<0.01), but in ID group 1 month after surgery. Biting pain was improved and maintained it after surgery and not significant difference between two groups. Headache and neck/shoulder pain were much improved after surgery(p<0.01), but slight relapse was found in adhesion group after 12 months. TMJ sound was more found in adhesion group after 1 month(p<0.05), but after 3 months, no significant difference was found between two groups. Conclusions: The postoperative results of adhesion group were worse than ID group. Therefore, it is considered more carefully to diagnose and treat in cases of internal derangement with adhesion.

• 대한치과의사협회지
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• 제48권7호
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• pp.522-530
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• 2010

Temporomandibular disorders(TMD) have been defined as a collective term embracing a number of clinical problems that involve the temporomandibular joint, the masticatory muscles, and associated structures. Since Dr. James Costen has mentioned about the relationship between TMD and posterior bite collapse, there have been many controversies about the etiology and comorbidities of TMD. The purpose of this study was to investigate the relationship between TMD and hearing acuity in 158 volunteers with or without TMD symptoms. The subjects were examined clinically about TMJ sound, missing teeth, tinnitus, TMJ pain and masticatory muscle pain and the hearing acuity were measured by Audiometer(ITO AE-1000, Japan). The result of this study indicated that there was no significant differences between TMD symptoms and hearing acuity relatively.

• 구강회복응용과학지
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• 제23권3호
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• pp.187-195
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• 2007

Temporomandibular disorders have been defined as a collective term embracing a number of clinical problems that involve the temporomandibular joint, the masticatory muscles, and associated structures. Since Dr. James Costen has mentioned about the relationship between TMD and posterior bite collapse, there have been many controversies about the etiology and comorbidities of TMD. The purpose of this study was to investigate the relationship between TMD and hearing acuity in 158 volunteers with or without TMD symptoms. The subjects were examined clinically about TMJ sound, missing teeth, tinnitus, TMJ pain and masticatory muscle pain and the hearing acuity were measured by Audiometer(ITO AE-1000, Japan). The result of this study indicated that there was no significant differences between TMD symptoms and hearing acuity relatively.

• Journal of Oral Medicine and Pain
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• 제16권1호
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• pp.85-93
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• 1991

In this study, 88 dental students were examined to evaluate the relationship between occlusal states and TM disorders for the epidemiologic study of TM disorders. The clinical evaluation were composed of mandibular movement, TMJ noise, occlusal states and muscle palpation. The following results were disclosed. 1. The frequencies of pain on mandibular movement were 3.4% on maximum opening, 1.13% on protrusion and no pain on laterotrusion. 2. The frequencies on TMJ sound were 21.6% in click, 1.13% in crepitus. 3. The frequency of tenderness on palpation was 12.5% on extra oral, intraoral and neck muscles, tenderness on palpation of TMJ capsule were reported 5 cases, and 4 of them were female. 4. The distribution of Angle's classification was found 79.5% in class I, 4.5% in clasII-div.1 and 15.9% in class III. There was no significant differences on TM disorders between Angles classifications. 5. There was no significant differences on TM disorders between the subjects of canine guided occlusion and group function occlusion, and also for the differences between the subjects of nonworking side interferences and no interferences on laterotrusion. 6. There was no significant differences on TM disorders between the subjects of anterior teeth trauma in C.C. and no anterior teeth trauma, but there were significant differences between the subjects of posterior protrusive contact and no posterior protrusive contact.

• Journal of Oral Medicine and Pain
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• 제48권1호
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• pp.31-36
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• 2023

This report presents the case of a 14-year-old male with rheumatoid arthritis (RA) in both temporomandibular joints (TMJs), in whom a bone scan and laboratory tests were used to confirm the diagnosis. The patient visited the Department of Orofacial Pain and Oral Medicine at the affiliation hospital with a complaint of a 1-year history of bilateral TMJ pain and sound. Clinical examination revealed bilateral TMJ and masseter muscle pain during mouth opening and palpation. Radiological examination revealed no significant morphological changes in either TMJ. The patient was prescribed medications at the first visit to address the pain, inflammation, and stiffness. A bone scan and laboratory tests were planned/scheduled for differential diagnosis between simple arthralgia and osteoarthritis. The bone scan revealed increased radiotracer uptake in both TMJs. The laboratory tests revealed a RA factor of 82.4 IU/mL, which is more than four times the normal range. The final diagnoses were bilateral TMJ early rheumatoid arthritis (ERA) and juvenile idiopathic arthritis. We created a stabilization splint and referred the patient to the Department of Rheumatology for further evaluation of the ERA. After fitting of the stabilization splint and giving instructions regarding its use, the patient has been receiving monthly follow-up checks for symptoms and undergoes follow-up blood tests every 3 months. About 14 months after the initial visit, the pain had significantly decreased from a Visual Analog Scale score of 5 to 1, and the RA factor decreased to 66.6 IU/mL. A regular follow-up check will continue until the end of growth.

• 치과방사선
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• 제14권1호
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• pp.121-134
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• 1984

The authors analyzed the morphological change of bone structure from 3,140 radiographs (1570 joints) of 785 patients with temporomandibular joint arthrosis, which were obtained by the oblique lateral transcranial projection and orthopantomographs. The interrelation of bone change and clinical symptoms, duration of the diseases were examined. Also, the bone changes of articular eminence, condyle, articular fossa were examined according to positional change of the condyle in the mouth open and close state. The results were as follows. 1. In the 785 patients with TMJ arthrosis, 782 patients (99.62%) show the positional change of the condyle. Among them 691 patients (88.03%) show the bone change. 2. In TMJ arthrosis patients with bone changes 451 patients (65.27%) showed both the condylar positional changes and bone changes bilaterally. 198 patients (28.65%) show the condylar positional changes bilaterally and bone changes unilaterally. 3. The bone changes in the TMJ arthrosis were in order of frequency eburnation (647 cases, 32.8%), erosion (548 cases, 27.79%), flattening (418 cases, 21.20%), deformity (138 cases, 6.99%). sclerosis (115 cases, 5.83%), marginal proliferation (106 cases, 5.38%). The region of bone change in TMJ arthrosis with condylar positional changes were in order of frequency the articular eminence (43.97%) condylar head (38.64%), articular fossa (17.39%). In the patients with bone changes, their clinical symptoms were pain (44.34%), clicking sound (33.5%), limitation of mouth opening (22.52%). In the patients complaining pain the most frequent bone change was erosion (28.60%), in the patients complaining clicking sound, eburnation (28.97%) in the patients complaining the limitation, eburnation (29.40%). Also in the patients with the duration below 1 year most common bone change was eburnation. 5. The most common condylar positional change was downward position (39.94%) in closed state, restricted movement of condyle (30.07%) in open state. The condylar positional changes and bone changes according to the region were as follows: a) In the condylar head the most frequent bone change was erosion (30.45%) and the most frequent condylar positional change was downward position (37.40%) in closed state, restricted movement of condyle (33.2%) in open state. b) In the articular eminence the most frequent bone change was eburnation (39.91%) and the most frequent condylar positional change was downward position (39.79%) in closed state, restricted movement of condyle (27.22%) in open state. c) In the articular fossa the most frequent bone change was eburnation (53.94%) and the most frequent condylar positional change was downward position (42.57%) in closed state, restricted movement of condyle (30.32%) in open state.

• Journal of Oral Medicine and Pain
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• 제21권1호
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• pp.67-78
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• 1996

This study was performed to compare the TMJ sounds by means of vibration-related items by Sonopak such as integral, high integral, above 300/(0-300) ratio, peak amplitude, peak frequency and median frequency before and after occlusa1 splint therapy as well as counselling, physical modalities. For this study 22 patients with craniomandibular disorders (CMDs) were selected and examined by routine diagnostic procedure for CMDs including Transcranial and Panoramic radiographs and were classified into 3 CMDs subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Visual analogue scale (VAS) about joint sound was recorded during treatment period and VAS treatment index (VAS Ti) was calculated from the VAS data and treatment duration. The author evaluated and compared treatment results by several parmeters such as symptom duration, timing of joint sound, parafunctional habits, trauma, and diagnostic classification. The obtained results were as follows : 1. Before the treatment, the highest value of peak amplitude was observed in disc displacement with reduction group and value of median frequency was highest in degenerative joint disease group. In addition the highest values of peak frequency and ratio ware observed in degenerative joint disease group, though they were not significant. Furthermore the lowest value of high integral was observed in disc displacement without reduction group and though it was not significant, value of integral was lowest in that group. 2. Among 3CMDs subgroups disc displacement with reduction group showed the significantly decreased value of high integral and degenerative joint disease group had the significantly decreased value of integral after conservative treatment including occlusal splint therapy. Conclusively conservative treatment including occlusal splint therapy vay be effective in the treatment of CMDs including TMJ sound. 3. Fair prognosis for conservative treatment was observed in acute group under 6 months than chronic group, 6 months over in symptom duration but there was no statistical difference. The result for conservative treatment was observed slightly poor in subjects with bruxism, clenching, unilateral chewing habit and trauma history but there were no statistical differences.

• 치과방사선
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• 제12권1호
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• pp.69-80
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• 1982

The author analyzed the morphologic changes of bone structures from 1256 radiographs of 314 patients with temporomandi.bular joint arthrosis, which were obtained by the oblique-lateral projection and orthopantomography. The interrelations of the bone changes and clinical symptoms were examined. Also, the positional relationships of condylar head, articular fossa and articular eminence in the mouth open and closed state were observed in the patients with bone changes. The results were as follows; 1. The most frequent bone change in the TMJ arthorsis was eburnation of cortical bone (35. 64%) of total cases). Then came bone surface erosion and localized radiolucency (26.18%), marginal proliferation (9.7%) and flattening of articular surface (9.58%) in that order. 2. The most frequent site of bone change was articular eminence (41.70%). The came condylar head (21.09%) and articular fossa (20.73%) in that order. 3. In the patients with bone changes, their clinical symptoms were pain (51.55%), clicking sound during mandibular movement (37.71%) and limited mandibular movement (10.73%). In the patients complaining pain, their radiographs showed eburnation of cortical bone (30.68%), bone surface erosion and localized radiolucency (27.45%) and flattening in the (30.68%), bone surface erosion and localized radiolucency (27.45%) and flattening of articular surface (10.68%). 4. The condylar positional changes in the TMJ arthrosis patients with bone changes were as follows: in the mouth closed !tate, there were the widening of joint space in 624 cases (50.00%), the narrowing of joint space in 543 cases (43.47%) and bone on bone relatioships in 82 cases (6.57%). In the mouth open state, there were forward positioning of the condyle in 332 cases (28.55%), limitation of movenent in 332 cases (28.55%), bone on bone relation- ships in 248 cases (21.31%) and downward positioning of condyle in 217 cases (18.66%). bone on bone relationships in 243 cases (21.32%) and downward positioning of condyle in 217 cases (18.66%). 5. In the TMJ arthrosis patients with bone changes, 1249 cases of abnormal condylar position in the mouth closed state and 1163 cases of abnormal condylar position in the mouth open state could be interpreted. so, for the radiographic interpretation of TMJ arthrosis, the reading of condylar positional changes as well as that of bond changes should be performed and their interrelations should be profoundly considered.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권4호
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• pp.367-374
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• 2007

Purpose: The diagnostic relevancies and characteristics and of clinical methods in the diagnosis of internal derangement(ID) were tested by comparing the results of them with those of magnetic resonance imaging(MRI). Methods: 75 patients(150 temporomandibular joints; TMJs), who were suspected to have ID by clinical diagnoses, were included. Clinical diagnoses including mouth opening pathway and TMJ sound were conducted and MRI takings were done. Accuracies, sensitivities, specificities, positive predictive values, and negative predictive values of clinical diagnosis, mouth opening pathway, and TMJ sound were calculated by comparing with diagnoses with MRIs. Results: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis were 59.3%, 83%, 49%, 81%, and 51%. They were 59%, 82%, 25%, 73%, and 35% for mouth opening pathways. Although deviation was somewhat accurate for representing disc displacement with reduction(ADDWR), other discrepancies on opening pathways were not clinically relevant. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clicking sounds were 85%, 49%, 78%, 85%, and 37%. TMJs with crepitus were only three. But all TMJs with crepitus were diagnosed to have disc displacement without reduction(ADDWOR). Conclusion: When compared with diagnoses with MRIs, clinical diagnoses for ID were not so accurate. But they were suitable for screening tests for ID. Opening pathways and TMJ sounds were not so relevant in the diagnoses of IDs and so it was concluded that considerations for other factors must be included in the diagnoses of IDs.