Application of cone beam computed tomography for assessment of the temporomandibular joints

Abstract

Radiographic examination is essential for the diagnosis and management of temporomandibular joint (TMJ) disorders. The goals of TMJ radiography are to evaluate cortical and trabecular architecture of the bony structures and confirm their integrity, to assess the extent and monitor progression of osseous changes, and to evaluate the response to treatment. Accurate evaluation of the TMJ by conventional radiography is limited by structure superimposition. Cone beam computed tomography (CBCT) provides high-resolution multiplanar images and delivers substantially lower radiation dose, compared with multislice CT. CBCT allows examination of TMJ anatomy without superimposition and distortion to facilitate analysis of bone morphology, joint space and dynamic function in all three dimensions. This article will describe the role of CBCT imaging for the assessment of the TMJ osseous structures and present typical appearances of common pathological conditions of the TMJ.Keywords: Cone beam, temporomandibular joints.Abbreviations and acronyms: CBCT = cone beam computed tomography; CH = coronoid hyperplasia; CT = computed tomography; FOV = field of view; MRI = magnetic resonance imaging; OA = osteoarthritis; RA = rheumatoid arthritis; SC = synovial chondromatosis; TMD = temporomandibular disorders; TMJ = temporomandibular joints.

Role of Cone Beam Computed Tomography in Dentistry

“…CBCT has a capability to detect early changes in TMJ osteoarthritis like irregular cortical outlines, erosions, osteophyte formation, subchondral cyst formation, narrowing of joint space, flattening of articular surfaces and sub-chondral sclerosis [32,33]. Similar changes are also found in inflammatory disorders but to a Figure 4A).…”

Temporomandibular joint diagnostics using CBCT

“…86 In addition, reports of cases have been published, such as synovial chondromatosis, 87,88 fibrous ankylosis in RA 89 and metastasis of a bronchial carcinoma. 90 Similar rare conditions have been illustrated in previously mentioned review articles, 5,6 which also showed trauma and developmental cases. Condylar fractures can be nicely demonstrated with CBCT ( Figure 9) and so can developmental anomalies (Figure 10).…”

“…4 Available literature on CBCT has become extensive since then, including reviews for application to the TMJ. [5][6][7][8] The present overview will give an update on TMJ imaging using CBCT and its diagnostic value compared with other imaging modalities, with main sections on diagnostic accuracy and OA. The usefulness of CBCT in the diagnostic assessment of other TMJ conditions will be shortly reviewed.…”

Current Management of Temporomandibular Joint (TMJ) Disease

“…CBCT provides high-resolution multiplanar images and emits a significantly lower radiation dose compared with CT. CBCT machines are less bulky and available in the community, whereas multiplanar CT is only available in a hospital environment. CT provides accurate hard tissue information but poor soft tissue visualisation [6].…”