Imaging of Erosions and Osteophytes in the Temporomandibular Joint

METHODS: A search of PubMed, Medline, all EBM reviews (Cochrane Database of Systematic Reviews, ASP Journal Club, DARE and CCTR), Embase, Web of Sciences, and Lilacs identified nineteen articles that met initial inclusion criteria: use of some type of TMJ diagnostic imaging and evaluation of the presence of erosions and/or osteophytes. The original articles were then retrieved. A methodological checklist was used to evaluate the quality of the selected articles. References from the selected articles were also hand-searched for possible missing articles. One article was found based on this secondary search. Additional selection criteria were used to select the appropriate articles from their published abstracts: use data from autopsy or dry skull TMJ's as gold standard and the absence of diagnosed osteoarthritis. A total of five articles remained in the final selection.

RESULTS: One study evaluated panoramic imaging (unenhanced and color-enhanced digital subtraction panoramic imaging), one article compared biplanar multidirectional tomography and panoramic images, two articles used corrected sagittal tomography and one article used corrected sagittal and frontal tomography. Although several diagnostic methods are used all of them present some limitations in accurately quantify erosions and/or osteophytes location, size and volumes.

CONCLUSION: Panoramic imaging has low diagnostic value in detecting TMJ erosions and osteopytes. Biplanar (sagittal and coronal) tomography is more accurate than panoramic imaging in detecting lesions. Correct sagittal tomography appears to be the most reliable method to evaluate TMJ erosions and osteophytes. Minimal additional information is gained from frontal tomography. Recent advances in imaging techniques have highlighted the need for future studies. Evaluation of CT and Cone beam CT imaging are promising tools to advance current TMD diagnostic standards.