Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard

Abstract

Three-dimensional imaging modalities have been reported to be more accurate than panoramic radiographs (PR) for the assessment of bone components of the temporomandibular joint (TMJ). No exact prior information is available that demonstrates which specific limitations occur in terms of TMJ diagnosis when using PR for this purpose. This study aimed to assess the clinical validity of digital panoramic radiography (DPR) when diagnosing morphological disorders of the TMJ using cone-beam computed tomography (CBCT) images as the gold standard. A sample composed of TMJ images (N = 848), including 212 DPR and 212 CBCT images obtained from the same patient, was used to assess any morphological changes in the TMJ. Four appraisers diagnosed all of the DPR images, whereas the CBCT images were used to establish the gold standard. The reliability of each appraiser's response pattern was analyzed using the Kappa test (κ), and diagnostic tests were performed to assess each appraiser's performance using a significance level setting of 5% (α = 0.05). Reliability of each appraiser's response pattern compared to the gold standard ranged from a slight-to-moderate agreement (0.18 ≤ κ ≤ 0.45); and among the different appraisers, the response pattern showed a fair agreement (0.22 ≤ κ ≤ 0.39). Diagnostic tests showed a wide range among the different possible morphological changes diagnosed. DPR does not have validity when diagnosing morphological changes in the TMJ; it underestimates the radiological findings with higher prevalence, and thus, it cannot be used effectively as a diagnostic tool for bone components within this region.

Assessment of Interexaminer Agreement in the Detection of Condyle Morphology and positioning with Two Methods: Radiographic and Tomographic

“…19 Indeed, the influence of head positioning during image acquisition also accounts for this limitation, 20 as well as the image formation, as the condyles are angled (15-33°) to sagittal plane making the X-ray beam projection obliquely to the condyle axis. 21 Tomographic scan is currently the method of choice in the evaluation of joint erosion or osteophytes. 22 Three independent observers compared CBCT and CT images of the TMJ and analyzed the changes in the mandibular condyle (flattening, defects, and osteophytes) and in the articular tubercle (flattening and defects).…”

Métodos De Imagem Empregados No Diagnóstico Das Alterações Da Articulação Temporomandibular: Uma Revisão De Literatura

“…No que se refere ao uso da Radiografia Panorâmica (RP) para o diagnóstico de alterações na ATM, um estudo relata que a RP é utilizada tanto para avaliar quanto para diagnosticar inicialmente a ATM, porém quando se refere às alterações morfológicas dessa articulação, a RP, pelo fato de apresentar distorções nas imagens, é contra indicada para tal análise, pois poderá sugerir um falso diagnóstico (9). Em contrapartida, deformações ósseas avançadas no côndilo, como fraturas, alterações de crescimento, anquiloses, tumores, e grandes alterações morfológicas do tubérculo articular, podem ser identificadas através da RP 8 .…”

“…Da mesma forma, um estudo de caso realizado no Brasil descreve que a TCCB é um método preciso para avaliar os componentes ósseos e as condições morfológicas das estruturas ósseas da ATM 9 .…”

An assessment of the accuracy of a panoramic radiograph as compared with cone-beam tomography in TMJ imaging

“…15 Nevertheless Pans still appear to be widely used for diagnosis of TMJ space deficiencies and bone disorders. [16][17][18] Since 1982, digital radiography has enabled the electronic storage of panoramic images for easy recall.…”

“…superimposition of structures, Pans are still currently being used to diagnose bony changes and joint space deficiencies and have allowed generally correct interpretation of the bony components of TMJ. 16 The question may be raised, however, as to what are the levels of agreement between the data measured on a Pan with that measured on the purportedly technically superior CBCT projection.…”