Long-term Changes of Temporomandibular Joint Osteoarthritis on Computed Tomography

Abstract

this study aimed to understand long-term changes of the osteoarthritic temporomandibular joint (tMJ) condyle using computed tomography (ct) and to verify its correlation with clinical characteristics of temporomandibular disorders. Eighty-nine patients (152 joints; 76 female, 13 male) who had taken follow-up CTs (mean follow-up period: 644.58 ± 325.71 days) at least once in addition to their initial evaluation were selected. cross-sectional demographic and clinical data and longitudinal ct images were collected. Data were analyzed by analysis of variance and logistic regression. overall destructive change index (number of tMJ condyle sections in which destructive change was observed) decreased from 1.56 to 0.66. Improvement was seen in 93 joints (61.2%) and 27 joints (17.8%) worsened. In the pain positive group, both initial and final destructive change index were significantly higher compared to the pain negative group (p = 0.04). Occlusal stabilization splint therapy and nonsteroidal antiinflammatory drug administration showed a significant effect on improving the prognosis of TMJ osteoarthritis (p = 0.015 and 0.011). In conclusion, TMJ osteoarthritis showed long-term improvement in the majority of cases. tMJ osteoarthritis accompanied by pain showed unfavorable prognosis with additional bone destruction. Occlusal stabilization splint and nonsteroidal anti-inflammatory drug administration were beneficial on the prognosis of TMJ osteoarthritis. Osteoarthritis (OA) is a debilitating degenerative disorder involving inflammatory conditions and osseous changes of the joints 1,2. Tissue damage caused by mechanical irritation may lead to the infiltration of inflammatory mediators originating from the synovium into the cartilage, eventually causing defects in cartilage metabolism. Catabolic processes overpower the anabolic capacity of chondrocytes with continued degeneration, tipping the homeostatic balance resulting in progressive cartilage destruction 1,3,4. Signs and symptoms of temporomandibular joint (TMJ) OA include pain, movement limitations, clicking and crepitus sounds, and most critically joint deformity that can be identified through radiographic imaging. Osseous changes of TMJ OA manifest as flattening, osteophyte formation, sclerosis, erosion, joint mice, and subchondral bone cysts. Destruction of the TMJ condyle can cause malocclusion and skeletal facial deformity, mainly retrognathism accompanied by anterior open bite and facial asymmetry. The TMJ condyle is a small bone that is surrounded by various adjacent structures that make visualizing detailed bony status difficult with plain radiography. Computed tomography (CT) images provide an advantageous view of osseous changes by allowing visualization of the bony structure in multiple dimensions with superior reliability and accuracy compared to panoramic radiographs and conventional tomography 5,6. The disagreement between the severity of clinical symptoms and radiographic evidence is well described in several previous studies of TMJ OA based on CT result...

Incidental findings of temporomandibular joint osteoarthritis and its variability based on age and sex

“…6 TMJ-OA affects the cartilage, subchondral bone, synovial membrane, and other hard and soft tissues, causing changes such as condylar flattening, sclerosis, resorption, erosion, subcondylar cyst, or osteophyte formation. 7 Degenerative changes in the form of erosion, sclerosis, or resorption of the articular eminence are also characteristic of TMJ-OA. [8][9][10] The results of epidemiological studies of the prevalence of TMJ-OA vary due to the existence of different diagnostic criteria for the condition.…”

“…The most notable challenge in assessing the prevalence of TMJ-OA is the widely recognized disparity between objective diagnosis based on imaging evidence and subjective findings in the form of patient reports of pain or disability. 7,14,15 However, objective diagnoses (such as those made using imaging modalities) provide more reproducible results and facilitate more accurate comparative studies than subjective findings. 15 Although several studies have provided evidence regarding the prevalence of OA of the knee or other joints, very little is known about the prevalence of TMJ-OA.…”

Temporomandibular Joint Osteoarthrosis: A Review of Clinical Aspects and Management

“…An increasing number of studies have recently focused on inflammation and remodelling of subchondral bone during the early stage of TMJ OA, which may elucidate the possible mechanism of initiation and progression of the disease. 7,8 It has been suggested that catabolic processes overpower the anabolic capacity of chondrocytes with continued degeneration, tipping the homeostatic balance and resulting in progressive cartilage destruction. 9,10…”

Orally Administered NSAIDs—General Characteristics and Usage in the Treatment of Temporomandibular Joint Osteoarthritis—A Narrative Review

“…These results clearly presented the positive aspect of adjuvant sodium diclofenac administration to occlusal splint therapy on earlier pain reduction. Song et al [ 75 ] found that therapy with occlusal stabilization splints as well as administration of NSAIDs significantly improved TMJ OA. The pharmacotherapy with diclofenac sodium lasted 61.91 ± 42.15 days (the dosage was not presented).…”

“…Table 2 presents the effectiveness of orally administered NSAIDs in the treatment of TMJ OA on the basis of the literature [ 73 , 74 , 75 , 76 , 77 , 78 ].…”