Do computed tomography and magnetic resonance imaging add to temporomandibular joint disorder treatment? A systematic review of diagnostic efficacy

Abstract

A question frequently asked in the clinical practice of the professional who treats temporomandibular joint disorders (TMJD) is 'To make the cost/benefit ratio worthwhile for the patient, when should I request a temporomandibular joint (TMJ) computed tomography (CT) or magnetic resonance imaging (MRI)?' To evaluate the evidence of the efficacy of CT and MRI in the diagnosis of disc displacement, local inflammatory disorders, and arthrosis of the TMJ at therapeutic efficacy level, PubMed and Cochrane literature searches with specific indexing terms and a hand search were made. From the retrieved titles and abstracts, three examiners selected publications on the basis of predetermined inclusion and exclusion criteria. Data were extracted from the selected publications using a previously established protocol. Publications considered relevant were interpreted with the aid of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and publications that critically evaluate systematic reviews. The literature search yielded 584 titles and abstracts, of which 257 were selected and read in full text. One study was judged relevant. This study evaluated evidence of the efficacy of MRI in the diagnosis of disc position and configuration, disc perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint, but no publication reported diagnostic thinking efficacy or therapeutic efficacy. In conclusion, the absence of studies on the therapeutic efficacy of MRI and CT on TMJD reinforces the need for investment in decision-making studies; meanwhile, sectional imaging tests should be prescribed with caution, especially when health budgets are limited.

Justification of full width panoramic radiography in Oral Surgery

“…Despite this, most dental panoramic units still have a ‘bilateral TMJ open and closed option’, and some even have an antero–posterior projection imaging facility despite the knowledge that dental panoramic tomography is of limited value in the diagnosis of disc displacement or degenerative disease processes of the TMJ . There is relatively limited high‐quality evidence to suggest which imaging modality is preferred when imaging of the TMJ is indicated . When suspected disc displacement is contributing to noise or trismus the preferred imaging modality is generally magnetic resonance imaging.…”

“…21 There is relatively limited high-quality evidence to suggest which imaging modality is preferred when imaging of the TMJ is indicated. [22][23][24][25] When suspected disc displacement is contributing to noise or trismus the preferred imaging modality is generally magnetic resonance imaging. Where degenerative osseous or hard tissue changes are suspected because of underlying systemic disease, pain or joint noise suggestive of degenerative changes then computed tomography, Table 3 Frequency distribution of specific segments required from 823 requests for dental panoramic tomograms (Fig.…”

Evaluation of the relationships between contrast-enhanced magnetic resonance characteristics and joint pain in patients with temporomandibular disorders

“…Magnetic resonance (MR) imaging is currently considered a useful modality for TMJ imaging in patients with TMDs, particularly for examining the position and configuration of the disk [2][3][4][5], inflammatory pathological changes in the posterior disk attachment [6][7][8][9], and presence of effusion in joint spaces [5,[10][11][12], and for assessing the bone marrow edematous involvement [13]. Furthermore, the usefulness of a frequency-selective fatsaturation T2-weighted imaging technique has been reported for precise detection of TMJ effusion [14], inflamed posterior disk attachment [8], and edema pattern in the mandibular condyle [15,16].…”

Small field of view cone beam CT temporomandibular joint imaging dosimetry

“…[1][2][3][4] While CT imaging provides superior views of the hard tissue components of the joint to twodimensional planar, panoramic and conventional tomographic techniques, one major drawback is its failure to adequately image the soft-tissue structures including the articular disc or its associated attachments. 5 The current standard of care at our institution for imaging the osseous structures of the TMJs is cone beam CT (CBCT), as this modality offers both a reduced radiation dose and a superior image quality compared with helical CT. 6,7 Our current protocol utilizes the Hitachi CB MercuRayÔ cone beam CT unit (Hitachi Medical Systems, Tokyo, Japan) with a 9 inch (22.9 cm) field of view, operating at 100 kVp and 10 mA.…”