Korean J Orthod.  2021 Mar;51(2):105-114. 10.4041/kjod.2021.51.2.105.

Relationship between rotational disc displacement of the temporomandibular joint and the dentoskeletal morphology

• Park SH
• Han WJ
• Chung DH
• An JS
• Ahn SJ

• KMID: 2513579
• DOI: http://doi.org/10.4041/kjod.2021.51.2.105

Abstract

Objective
The purpose of this study was to evaluate the relationship between rotational disk displacement (DD) of the temporomandibular joint (TMJ) and the dentoskeletal morphology.
Methods
Women aged > 17 years were included in this study. Each subject had a primary complaint of malocclusion and underwent routine cephalometric examinations. They were divided into five groups according to the findings on sagittal and coronal magnetic resonance images of their TMJs: bilateral normal disk position, bilateral anterior DD with reduction (ADDR), bilateral rotational DD with reduction (RDDR), bilateral anterior DD without reduction (ADDNR), and bilateral rotational DD without reduction (RDDNR). Twenty-three cephalometric variables were analyzed, and the Kruskal–Wallis test was used to evaluate differences in the dentoskeletal morphology among the five groups.
Results
Patients with TMJ DD exhibited a hyperdivergent pattern with a retrognathic mandible, unlike those with a normal disk position. These specific skeletal characteristics were more severe in patients exhibiting DD without reduction than in those with reduction, regardless of the presence of rotational DD. Rotational DD significantly influenced horizontal and vertical skeletal patterns only in the stage of DD with reduction, and the mandible exhibited a more backward position and rotation in patients with RDDR than in those with ADDR. However, there were no significant dentoskeletal differences between ADDNR and RDDNR.
Conclusions
The results of this study suggest that rotational DD of TMJ plays an important role in the dentoskeletal morphology, particularly in patients showing DD with reduction.

Keyword

Temporomandibular joint; Cephalometrics; Classification; Disk displacement

Figure

• 

  Figure 1 Coronal images of the temporomandibular joint showing the disk (arrow) interposed between the condyle (Co) and articular eminence (Em) in the closed mouth position. A, Normal disk position. B, Medial disk displacement. C, Lateral disk displacement.

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  Figure 2 Landmarks used for measurements in the study. 1, nasion; 2, sella; 3, orbitale; 4, porion; 5, anterior nasal spine; 6, posterior nasal spine; 7, articulare; 8, point A; 9, incisal end of maxillary incisor; 10, apex of maxillary incisor; 11, incisal end of mandibular incisor; 12, apex of mandibular incisor; 13, point B; 14, pogonion; 15, menton; 16, gonion; and 17, articulation of maxillary and mandibular molars.

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  Figure 3 Linear measurements obtained in the study. 1, N-perpendicular to point A; 2, N-perpendicular to pogonion; 3, ramus height; 4, mandibular body length; 5, total mandibular length; 6, mandibular body length ratio (mandibular body length/total mandibular length); 7, anterior facial height; 8, posterior facial height; 9, facial height ratio (posterior facial height/anterior facial height); 10, overbite; and 11, overjet.

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  Figure 4 Angular measurements obtained in the study. 1, gonial angle; 2, maxillomandibular plane angle; 3, Frankfort horizontal plane to mandibular plane angle (FMA); 4, sella-nasion-A point angle (SNA); 5, sella-nasion-B point angle (SNB); 6, A point-nasion-B point angle (ANB); 7, ramus inclination; 8, interincisal angle; 9, mandibular incisor to Frankfort horizontal plane angle (FMIA); 10, mandibular incisor to mandibular plane angle (IMPA); 11, maxillary incisor to sella-nasion plane angle; and 12, maxillary incisor to Frankfort horizontal plane angle.

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  Figure 5 Dentoskeletal variables with significant differences between subjects with bilateral anterior disk displacement with reduction (ADDR) and those with bilateral rotational disk displacement with reduction (RDDR). ANB, A point-Nasion-B point angle; FMA, Frankfort horizontal plane to mandibular plane angle. Mann–Whitney U test; *p < 0.05.

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  Figure 6 Profilogram comparisons among five groups stratified according to the position of the temporomandibular joint disk on coronal and sagittal magnetic resonance images.

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