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      Cone-Beam Computed Tomographic Assessment of Mandibular Condylar Position in Patients with Temporomandibular Joint Dysfunction and in Healthy Subjects

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          Abstract

          Statement of the Problem. The clinical significance of condyle-fossa relationships in the temporomandibular joint is a matter of controversy. Different studies have evaluated whether the position of the condyle is a predictor of the presence of temporomandibular disorder. Purpose. The purpose of the present study was to investigate the condylar position according to gender in patients with temporomandibular disorder (TMD) and healthy controls using cone-beam computed tomography. Materials and Methods. CBCT of sixty temporomandibular joints in thirty patients with TMD and sixty joints of thirty subjects without TMJ disorder was evaluated in this study. The condylar position was assessed on the CBCT images. The data were analyzed using Pearson chi-square test. Results. No statistically significant differences were found regarding the condylar position between symptomatic and asymptomatic groups. Posterior condylar position was more frequently observed in women and anterior condylar position was more prevalent in men in the symptomatic group. However, no significant differences in condylar position were found in asymptomatic subjects according to gender. Conclusion. This study showed no apparent association between condylar positioning and clinical findings in TMD patients.

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          Most cited references40

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          Accuracy of cone-beam computed tomography imaging of the temporomandibular joint: comparisons with panoramic radiology and linear tomography.

          Cone-beam computed tomography (CBCT) is increasingly being used as an imaging modality, particularly in the assessment of the temporomandibular joint (TMJ). A blinded observational cross-sectional in-vitro study was conducted to compare the diagnostic accuracy of observers viewing images made with CBCT, panoramic radiography, and linear tomography. The task was to detect cortical erosions affecting the mandibular condylar head. The sample consisted of 37 TMJ articulations from 30 skulls with either normal condylar morphology (n = 19) or erosion of the lateral pole (n = 18). The articulations were imaged by using corrected angle linear tomography (TOMO), normal (Pan-N) and TMJ-specific (Pan-TM) panoramic radiography, and CBCT. Digital images were obtained with photostimulable phosphor plates for all modalities except CBCT. The CBCT detector used an amorphous silicon flat-panel array combined with cesium iodide. Images and 10 rereads were presented to 10 observers on a flat-panel display at a pixel-to-monitor ratio of 1:1. CBCT multi-planar images were presented both statically (CBCT-S) and interactively (CBCT-I). The observers were permitted to scroll through axial (0.4 mm) and para-sagittal (1 mm) sections and then independently rate their confidence about the presence or absence of cortical erosion. Intraobserver reliability was determined by weighted kappa and diagnostic accuracy by the fitted area under the ROC curve. Means were compared by using ANOVA (P < or =.05). Intraobserver reliability was moderate (0.57 +/- 0.22; range, 0.34-0.78). Pan-N (0.72 +/- 0.15), CBCT-I (0.65 +/- 0.21), and CBCT-S (0.65 +/- 0.17) reliability was significantly greater than TOMO (0.44 +/- 0.25). The diagnostic accuracy of CBCT-I (0.95 +/- 0.05) and CBCT-S (0.77 +/- 0.17) was significantly greater than all other modalities (Pan-N [0.64 +/- 0.11], Pan-TM [0.55 +/- 0.11], TOMO [0.58 +/- 0.15]). CBCT-I was also more accurate than CBCT-S, and Pan-N was more accurate than Pan-TM and TOMO. CBCT images provide superior reliability and greater accuracy than TOMO and TMJ panoramic projections in the detection of condylar cortical erosion.
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            Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography.

            Cone beam computed tomography (CBCT) is making headway into imaging for orthodontics. The purpose of this study was to define CBCT multi-planar reformatted projections for temporomandibular joint (TMJ) examination and compare the accuracy of linear measurements of the TMJ and related structures from these projections with similar measurements made with conventional cephalograms and with the anatomic truth. Linear dimensions between 11 anatomical sites were measured with a digital caliper to assess the anatomic truth for 25 dry human skulls. The skulls were imaged with iCAT (Xoran Technologies, Ann Arbor, Mich/Imaging Sciences International, Hatfield, Pa) CBCT, and cephalograms were made in all 3 orthogonal planes (lateral cephalometric [LC], posteroanterior [PA], and submentovertex [SMV]) acquired with photostimulable phosphor plates. Linear measurements were made on 7 custom CBCT reconstructions and the digital cephalograms. Modality means and the natural log of the standard deviations were compared post hoc against the actual dimensions by using analysis of variance with the Dunnett t test. Significance was set at P < .05. All CBCT measurements were accurate; however, 3 of 5 LC measurements, 4 of 5 PA measurements, and 4 of 6 SMV measurements varied significantly from the truth. Intraobserver CBCT measurements were highly reliable compared with anatomic truth and significantly more reliable than measurements made from LC, PA, and SMV images. Custom oblique multi-planar reformatted reconstructions with iCAT CBCT provide accurate and reliable linear measurements of mandibular and TMJ dimensions.
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              Accuracy in measurement of distance using limited cone-beam computerized tomography.

              The purpose of this study was to evaluate the accuracy of measurement of distance on the images produced by limited cone-beam computerized tomography (CT). Five cadaver mandibles were examined by spiral computerized tomography (SCT) and limited cone-beam computerized tomography (LCBCT). The vertical distance from a reference point to the alveolar ridge was measured by caliper on the sliced mandible, and measurement error on the CT images was calculated in percentages based on the actual values and the measurement values obtained from the CT images. Measurement error was determined to range from 0 to 1.11 mm (0% to 6.9%) on SCT and from 0.01 to 0.65 mm (0.1% to 5.2%) on LCBCT, with measurement errors of 2.2% and 1.4%, respectively (P < .0001). This study suggests that distance can be measured accurately using LCBCT. The size of the rectangular solid images obtained using LCBCT (30 mm wide and 42.7 mm long) is thought to be adequate for observation of mandibular bony structure and for preoperative assessment before dental implant placement. In this experiment on cadaver mandibles, LCBCT was shown to be a useful tool for preoperative evaluation in dental surgery because the relatively small field size of its images limits the patient's exposure to radiation.
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                Author and article information

                Journal
                Int J Dent
                Int J Dent
                IJD
                International Journal of Dentistry
                Hindawi Publishing Corporation
                1687-8728
                1687-8736
                2015
                23 November 2015
                : 2015
                : 301796
                Affiliations
                1Oral Radiology Department, Dental School, Shiraz University of Medical Sciences, Shiraz 7145613466, Iran
                2Prevention of Oral and Dental Disease Research Center, Dental School, Shiraz University of Medical Sciences, Shiraz 7145613466, Iran
                3Radiology Department, Medical School, Shiraz University of Medical Sciences, Shiraz 7145613466, Iran
                Author notes

                Academic Editor: Francesco Mangano

                Article
                10.1155/2015/301796
                4670875
                7a809a59-00e1-4641-938c-815267db5b7c
                Copyright © 2015 Maryam Paknahad et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 1 October 2015
                : 27 October 2015
                Categories
                Research Article

                Dentistry
                Dentistry

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