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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 17-22

Comparison of temporomandibular changes in edentulous and dentulous patients using digital panoramic imaging


Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Satara, Maharashtra, India

Date of Submission16-May-2019
Date of Acceptance19-Sep-2019
Date of Web Publication24-Jan-2020

Correspondence Address:
Nikhil Rajesh Gharge
(Intern - BDS), Department Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Satara, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_18_19

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  Abstract 


Introduction: Prevalence of TMJ disorder in general population is approximately 50% out of which 3-7% are reported to seek treatment. Various modalities are used to diagnosis TMJ like Panoramic Imaging, Computed Tomography, Magnetic Resonance Imaging, Cone Beam Computed Tomography. The Present study is to design and analyse TMJ changes in Edentulous and Dentulous using Digital Panoramic Imaging.
Methodology: Retrospective study was carried out using 208 Panoramic Radiographs retrieved from Department of Oral Medicine and Radiology TMJ changes have assessed and Compared between the Dentulous and Edentulous patients.
Results: Out of 208 patients,103 individual were Dentulous and 105 were edentulous (94-Partially, 11-Complete). So in Dentulous patients female were predominately affected by TMJ changes, whereas in edentulous patients males were affected by TMJ changes. In dentulous patients flattening was most common followed by resorption whereas in edentulous resorption was most common followed by osteophyte in tmj region.
Conclusion: In our study in comparison of TMJ changes in edentulous and Dentulous patients showed flattening as most common changes in dentulous patients with female predominately and resorption as most common changes in edentulous patients with male predomiently.

Keywords: Articular eminence, condyle, flattening, glenoid fossa


How to cite this article:
Gharge NR, Ashwinirani S R, Sande A. Comparison of temporomandibular changes in edentulous and dentulous patients using digital panoramic imaging. J Oral Res Rev 2020;12:17-22

How to cite this URL:
Gharge NR, Ashwinirani S R, Sande A. Comparison of temporomandibular changes in edentulous and dentulous patients using digital panoramic imaging. J Oral Res Rev [serial online] 2020 [cited 2020 Feb 18];12:17-22. Available from: http://www.jorr.org/text.asp?2020/12/1/17/276702




  Introduction Top


Temporomandibular joint (TMJ) is one of the fascinating and complex synovial systems in the body.[1] It is the area in which the mandible articulates with the cranium. TMJ is referred to as “ginglymodiarthrodial,” which means a combination of the term “ginglymoid” (rotation) and “arthrodia” (translation).

The TMJ is under certain load during function, loss of teeth or tooth wear may compromise the occlusion and condylar position in dentulous and edentulous patients. These alterations in condylar position in time can result in the structural changes of the TMJ. The function of the TMJ is unique, in which the condyle both rotates within the fossa and translates anteriorly along the articular eminence. Temporomandibular disorder is an umbrella term that includes anatomical and physiological disorders associated with the temporomandibular joints. The prevalence of TMJ disorders is higher in women than in men.[2]

Various epidemiological prevalence studies have shown that approximately 50% of the general populations may experience symptoms or signs of temporomandibular disorder (TMD), but only 3%–7% of the general populations are reported to seek treatment, people who seek treatment are women in the second and third decades of life. TMJ imaging may be necessary to supplement the information obtained from the clinical examination.[3] It is useful particularly when an osseous abnormality is detected.[4] Screening projection used for TMJ includes panoramic imaging, computed tomography (CT), magnetic resonance imaging, cone-beam CT, and arthrography.[5] With this background, the present study is designed to analyze the TMJ changes in edentulous patients and dentulous patients and to compare the changes between them using panoramic imaging since it is comparatively cheaper when compared with other advanced modalities.


  Methodology Top


A retrospective study was conducted at the Department of Oral Medicine and Radiology in the School of Dental Sciences. A total of 208 panoramic images taken with orthopantomography (OPG) Machine Carestream Dental CS 8100 Family were being used for study, out of 208 patients, 105 Group A (edentulous) and 103 Group B (dentulous) were divided. All panoramic images will be observed for bony changes in the condyle, glenoid fossa, and articular eminence of TMJ region bilaterally. The changes in TMJ are recorded. The TMJ is assessed as follows: (0) no changes, (1) erosion, (2) Flattening [Figure 1], (3) osteophyte, (4) Sclerosis [Figure 2], (5) resorption, (6) changes in articular eminence, (7) changes in glenoid fossa, and (8) bifid condyle.
Figure 1: Orthopantomograph showing flattening of condyle on the right side temporomandibular joint and normal condyle on the left side

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Figure 2: Orthopantomograph showing sclerosis on the left side temporomandibular joint and normal condyle on the right temporomandibular joint

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All the data collected were entered into Microsoft excel and subjected to statistical analysis.


  Results Top


Out of a total of 208 patients, 103 dentulous individuals aged 18–68 years were evaluated. Among the gender, the females accounted for 60% of the total sample. [Table 1] displays the general demographic data. On analysis, it was found that score 2 (flattening) was more common followed by score 5 (resorption) and commonly age category that was affected was 18–28 followed by the age category 29–38 [Table 1].
Table 1: Temporomandibular joint changes in dentulous patients

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One hundred and five individuals, aged 18–68 years were evaluated for edentulous among which 11 were completely edentulous and 94 were partially edentulous, so among the male gender accounted for 63.63% of the data sample, as shown in [Table 2]. On analysis, it was found that score 5 (resorption) was more common followed by score 3 (osteophyte), and the common age affected was from 39 to 48 years [Table 2].
Table 2: Temporomandibular joint changes in complete edentulous patients

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In partially edentulous patients, the female gender accounted for 53.1% of the data sample, as shown in [Table 3]. On analysis, it was found that score 2 (flattening) was more common followed by score 3 (osteophyte) and common age affected was from 39 to 48 [Table 3].
Table 3: Temporomandibular joint changes in partially edentulous patients

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  Discussion Top


The TMJ is the only movable joint of the head, and it is composed of the upper articular surface, the lower articular surface, the articular disc, the articular capsule, and the articular ligament. The factors which play a dominant role in determining the area position the articular surfaces are the two antagonizing dental arches; their ultimate relation determines the definite area relation of the craniomandibular relationship.

Various epidemiological studies have presented different opinions on the prevalence of TMD signs in the dentate populations.[6],[7],[8] Despite the prevalence of TMD in the elderly population, 15%–25% edentulous subjects generally do present changes in the TMJ. Moreover, loss of teeth results in cessations of proprioceptive feedback from teeth to TMJ. Along with loss of teeth, emotional stress and advancing age predispose edentulous patients for increased TMD.

Ireland E V4 in 1953 stated that loss of posterior teeth may allow the bite to close and cause the mandible, as a whole to be forced in a backward direction by the action of the inclined planes of the incisor.[9] The condyles are driven into position above and behind their normal position in relation to the articular eminence. Only one condyle is effected when a unilateral cause is responsible, but when the bite has a closed, both are effected.[2]

In the present study, we evaluated different bony changes of the condyle seen on patients TMJ using OPG. The diagnostic reliability of OPG radiographic techniques to see the condylar bony changes were assessed and compared with each other. In our study, we used the machine Carestream Dental CS 8100 Family extraoral imaging system to obtain OPG. Using the study, we justified by a study done by Shetty et al.[1] in which the authors compared six different OPG and DVT systems to assess the condylar bony patterns.

Different bony changes assessed in our study are as follows:

  • 0: Normal TMJ
  • 1: Erosion
  • 2: flattening
  • 3: osteophyte
  • 4. Sclerosis
  • 5: resorption
  • 6: changes in articular eminence
  • 7: changes in glenoid fossa
  • 8: bifid condyle.


Erosion is defined as an area of decreased density of the cortical bone and the adjacent subcortical bone. Flattening is defined as a flat bony contour deviating from the convex form. Osteophyte is defined as an area of increased density of cortical bone extending into the bone marrow. Resorption is defined as partial loss of the condylar head.[1],[10] In our study, out of 208 OPG, 103 were dentulous patients and 105 were edentulous (partially − 94, complete 11).

According to the available literature, bony changes of TMJ are more common in female than in male. In our study, out of 208 patients, in dentulous, 60.19% females were affected and 39.80% males were affected and in complete edentulous 63.63% males were affected and 36.36% females were affected, and in partially edentulous patients 53.19% females were effected and 46.80% males were affected. The results of the present study show that more commonly bony changes such as erosion, flattening, osteophytes, and sclerosis are more commonly seen in females (67.75%) than males (32.25%). This is in accordance with the study done by Shetty et al.[1] The greater occurrence in women may be explained by the hormonal influences of estrogen and prolactin, which may exacerbate degradation of cartilage and articular bone in addition to stimulate a series of immunological responses in the TMJ.

In our study, flattening was the most common bony change noted in dentulous patients. It is a flat-bony contour deviating from the convex form and is considered a degenerative alteration resulting from overload on the TMJ and it is related to the involvement of the masseter and temporal muscles. In our study, 25.24% of flattening was found. In our study, resorption is the second-most bony change noted as it is a partial loss of the condylar head which includes 16.50% flattening.

The most common bony change in edentulous patients is flattening with 31.91% and the second most change is osteophyte (30.85%). It occurs in an advanced stage of degenerative change when the body adapts itself to repair the joint. The osteophyte appears to stabilize and widens the surface in an attempt to improve the overload resulting from occlusal forces. Sclerosis, erosion, and bifid condyle are the other two bony changes seen in our study, but there was no significantly results, reason for no significant can be different can be attributed to small percentage of these changes observed in our study.

Various studies have been conducted on the significance of sex and age predilection on the position and shape of TMJ, which revealed an increase in the incidence of flattening, osteophyte, bifid condyle which has been evaluated in this study.


  Conclusion Top


In comparison of TMJ changes in edentulous and dentulous patients we have concluded flattening was the most common bony change in dentulous and partially edentulous patients where as, in completely edentulous patients resorption was the most common feature noted. The bony changes are more commonly seen in female than in male.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shetty US, Burde KN, Naikmasur VG, Sattur AP. Assessment of condylar changes in patients with temporomandibular joint pain using digital volumetric tomography. Radiol Res Pract 2014;2014:106059.  Back to cited text no. 1
    
2.
Ammanna S, Rodrigues A, Shetty NS, Shetty K, Augustine D, Patil S. A tomographic study of the mandibular condyle position in partially edentulous population. J Contemp Dent Pract 2015;16:68-73.  Back to cited text no. 2
    
3.
Scarfe WC, Farman AG. What is cone-beam CT and how does it work? Dent Clin North Am 2008;52:707-30, v.  Back to cited text no. 3
    
4.
Patil S, Prasanna R, Sressharsha TV, Prasanna BG. Prevalance of tempromandibular disorders in patients wearing complete dentures visiting a medical college in South India. Int J Contemp Med Res 2016;3:1954-7.  Back to cited text no. 4
    
5.
Ahn SJ, Kim TW, Lee DY, Nahm DS. Evaluation of internal derangement of the temporomandibular joint by panoramic radiographs compared with magnetic resonance imaging. Am J Orthod Dentofacial Orthop 2006;129:479-85.  Back to cited text no. 5
    
6.
Carrara SV, Conti PC, Barbosa JS. End of the first consensus on temporomandibular disorders and orofacial pain. Dent Press J Orthod 2010;15:114-20.  Back to cited text no. 6
    
7.
De Kanter RJ, Truin GJ, Burgersdijk RC, Van 't Hof MA, Battistuzzi PG, Kalsbeek H, et al. Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder. J Dent Res 1993;72:1509-18.  Back to cited text no. 7
    
8.
Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent 2010;38:392-9.  Back to cited text no. 8
    
9.
Ireland VE. The problems of 'the clicking jaw'. J Prosthet Dent 1953;3:200-12.  Back to cited text no. 9
    
10.
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;41:24-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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