Korean J Orthod.  2024 Sep;54(5):325-341. 10.4041/kjod24.089.

Correlations of temporomandibular joint morphology and position using cone-beam computed tomography and dynamic functional analysis in orthodontic patients: A cross-sectional study

• Xu B
• Park JJ
• Kim SH

• KMID: 2559821
• DOI: http://doi.org/10.4041/kjod24.089

Abstract

Objective
To correlate temporomandibular joint (TMJ) morphology and position with cone-beam computed tomography (CBCT) images, Joint Vibration Analysis (JVA), and Jaw Tracker (JT) to develop a radiation-free, dynamic method for screening and monitoring the TMJ in orthodontic patients.
Methods
A total of 236 orthodontic patients without symptoms of TMJ disorders who had undergone CBCT were selected for the JVA and JT tests in this cross-sectional study. TMJ position and morphology were measured using a three-dimensional analysis software. JT measurements involved six opening–closing cycles, and JVA measurements were performed using a metronome to guide the mouth opening–closing movements of the patients. The correlations among the three measuring devices were evaluated.
Results
Abnormalities in condylar surface morphology affected the mandibular range of motion. The cut-off value results show that when various measurement groups are within a certain range, abnormalities may be observed in morphology (area under the curve, 0.81; P < 0.001). A 300/< 300 Hz ratio ≥ 0.09 suggested abnormal morphology (P < 0.05). Correlations were observed among the maximum opening velocity, maximum vertical opening position, and joint spaces in the JT measurements. Correlations were also observed between the > 300/< 300 Hz ratio, median frequency, total integral, integral < 300 Hz, and peak frequency with joint spaces in the JVA measurements.
Conclusions
JT and JVA may serve as rapid, non-invasive, and radiation-free dynamic diagnostic tools for monitoring and screening TMJ abnormalities before and during orthodontic treatment.

Keyword

Temporomandibular joint; Cone-beam computed tomography; Joint vibration analysis; Jaw tracker

Figure

• 

  Figure 1 Definitions of reference planes. All the radiographs were oriented in the coronal, sagittal, and axial planes. The horizontal plane (FH Plane) passes through the bilateral orbitale points and the midpoint of the bilateral porion points. The coronal plane was perpendicular to the FH plane, passing through the nasion. The sagittal plane was perpendicular to the coronal plane, passing through the nasion. Definition of the reference planes is provided by the ON3D program. FH, Frankfurt horizontal.

• 

  Figure 2 Landmarks and definitions of condylar reference planes. A, F, Cd-L in the axial plane; B, G, Cd-L in the coronal plane; C, H, Cd-M in the axial plane; D, I, Cd-M in the coronal plane; and E, J, the plane passing through the Cd-M and Cd-L and perpendicular to the FH plane is defined as the condylar coronal plane. The plane perpendicular to the condylar coronal and FH planes and passing through the condyle center is defined as the condylar sagittal plane. Definition of landmarks was provided by the ON3D program. Cd-L, condylar lateral pole; Cd-M, condylar medial pole; FH, Frankfurt horizontal.

• 

  Figure 3 Landmarks and measurements of condylar sagittal plane joint spaces. A, B, The condylar landmarks of the joint spaces in the condylar sagittal plane; C-F, measurements of the condyle in the condylar sagittal plane: anterior joint space (AJS), posterior joint space (PJS), and sagittal superior joint space (SSJS). Definition of landmarks was provided by the ON3D program. See Table 1 for definitions of each landmark or measurement.

• 

  Figure 4 Landmarks and measurements of condylar coronal plane joint spaces. A, B, Condylar landmarks of the joint spaces in the condylar coronal plane; C-F, measurements of the condyle in the condylar coronal plane: lateral joint space (LJS), medial joint space (MJS), and coronal superior joint space (CSJS). Definition of landmarks was provided by the ON3D program. See Table 1 for definitions of each landmark or measurement.

• 

  Figure 5 Condylar surface morphology. A, Normal, no changes; B, flattening, a flat bony contour deviating from the convex form; C, osteophytes, marginal bony outgrowths on the condyle; D, surface erosion, an area of decreased density of the cortical bone and adjacent subcortical bone; E, sclerosis, increased density of the cortical plate or bone under the cortical plate; and F, pseudocysts, osteolytic, well-delimited changes localized in the subcortical area.

• 

  Figure 6 Multiple measurement group’s workflow chart for judging condylar surface abnormality.

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