To compare radiographic and clinical diagnosis of Temporomandibular Osteoarthritis (TMJ OA) and TMJ health. A novel quantification methodology combining 3D surface modeling and a standardized protocol for the interpretation of cross-sectional slices to detect and quantify bone arthritic changes.
Using clinical Research Diagnostic Criteria for Temporomandibular Disorders at the patient’s first diagnostic appointment, an Oral and Maxillofacial Pain specialist examined and diagnosed all subjects as having a healthy TMJ or TMJ OA. After 14 subjects were diagnosed with TMJ OA, 14 age and sex matched subjects with healthy TMJs were recruited. All subjects received a CBCT scan that was evaluated by construction of 3D mandibular condyle surface models and by an Oral Maxillofacial Radiologist using a standardized protocol for multi-planar cross-sectional slices. The diagnostic index of osteoarthritis included flattening, localized or generalized sclerosis, subchondral cysts, erosion, osteophytes, and overall condylar resorption or condylar proliferations.
Three of the fourteen subjects (21.4%) with clinical diagnosis of TMJ OA presented indeterminate signs of radiographic OA in the multi-planar interpretation, but measurements in their surface models revealed flattening and bony projections. The radiographic index classified six patients as mild (42%), four as moderate, and four as severe. All OA patients presented flattening and erosions, and osteophytes were present in 93%. Radiographic findings indicative of OA were reported for seven (50%) of the subjects with clinical diagnosis of asymptomatic TMJs.
At initial clinical diagnosis of OA 58% of the patients presented moderate to severe osteoarthritic changes and 50% of asymptomatic patients presented radiographic changes. These preliminary findings suggest OA may have initial developmental stages in which it is asymptomatic and before it becomes symptomatic pathologic bony changes may have taken place, emphasizing the need for early detection and quantitative diagnostic methods.