Occlusal features that deviate from normative values have been historically considered risk factors for temporomandibular joint (TMJ) disorders. Nowadays, a putative association between dental occlusion and TMJ disorders remains controversial, with research findings on associations being inconsistent and inconclusive. We hypothesized that putative occlusal features identified during adolescence are associated with TMJ clicking later in life. The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study investigation of 1,037 children (48.4% female) born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973, and assessed repeatedly since then. Associations between posterior crossbite, overbite, and overjet at age 15, as well as both self-reported and clinically assessed TMJ clicking sounds at age 45, were studied. Data were analyzed using multivariate logistic regression, after controlling for sex, emotional style, self-reports of tooth clenching and sleep bruxism, and history of orthodontic treatment. Self-reported and examiner-reported TMJ clicking at age 45 affected 18.3% and 23.8% of the study sample, respectively, and were not associated with the presence of a posterior crossbite or abnormal overjet/overbite values during adolescence. Self-reported history of tooth clenching and emotional style were associated with self-reported TMJ clicking later in life. In addition, there is a suggestion that high overbite during adolescence is negatively associated with TMJ clicking later in life. A history of orthodontic treatment was not associated with TMJ clicking. Abnormal occlusal features, such as posterior crossbite and high and low overjet/overbite in adolescence, are not associated with higher prevalence of TMJ clicking later in life. Personality also appears to influence self-reports of TMJ clicking later in life.

Occlusal Features and TMJ Clicking: A 30-Year Evaluation from a Cohort Study:

To compare characteristics of temporomandibular joint (TMJ) and related structures according to Angle class I, II1, II2, and III. 123 Chinese patients (13–36 years old, 60 males, and 63 females) were classified in four groups according to Angle’s classification: skeletal class I (31 patients), skeletal class II division 1 (30 patients), skeletal class II division 2 (30 patients), and skeletal class III (32 patients). Left and right TMJs of each subject were evaluated independently with cone-beam computed tomography (CBCT). The position of condyle in the joint fossa was analyzed according to Pullinger. There were significant differences between class III subjects and class I, II1, II2 in the superior joint space (p < 0.05). Compared with class II1, II2, and III subjects, the height and diameter of condyle in class I was significantly larger (p < 0.05). The width of joint fossa was significantly larger in Angle class III than in Angle class I, II1, and II2, while the depth was significantly smaller. The condyle position in class III subjects was more anteriorly displaced compared with that in class I subjects. In class II2 patients, the condyle position was mainly concentric and posterior. There are significant differences in condylar morphology, joint space, joint fossa morphology, and condylar position between different Angle classifications.

Cone-beam CT evaluation of temporomandibular joint in permanent dentition according to Angle's classification

Evaluation of the temporomandibular joint (TMJ) pathologies with cone-beam computed tomography (CBCT) provides essential information about the bone structures of the TMJ. It is important to know the normal reference range when defining these pathologies. The aim of this study is to examine the morphometric and morphologic analyses of the bone structures of TMJ on the CBCT images in detail according to age, gender, and joint side. A total of 35 parameters related to the condylar process, articular tubercle, mandibular fossa, ramus of mandible, and joint space were examined on the CBCT images. These parameters were compared with the joint sides and gender, and correlated with age. Thirty-five parameters were evaluated. A statistically significant difference was found between genders in 22 parameters and joint sides in 6 parameters. When the correlation of parameters with age was examined; it was found that there was a very weak positive relationship in nine parameters, a weak positive relationship in one parameter, and a very weak relationship in the negative direction in two parameters. In this study, the condylar process, articular tubercle, mandibular fossa, ramus of mandible, and joint spaces, which are usually examined separately in the literature, were examined, and the normal reference range was determined for all these parameters. We think that these normal reference ranges will be useful for researchers interested in TMJ pathologies.

Morphometric evaluation of the temporomandibular joint on cone-beam computed tomography

A complex prosthodontic treatment is believed to be more successful when the condylar path is replicated using the articulator. However, there is an ongoing major disagreement between the researchers as the exact relationship between the posterior and anterior determinants has not been clear. The purpose of this study was to investigate whether the protrusive movement of the mandible does correlate with the temporomandibular joint (TMJ) anatomy or with incised features. Subjects (15 males and 15 females) were qualified for this study based on an initial interview including the following criteria: age 21–23 (+/−1), no history of trauma, orthodontic treatment, or temporomandibular disorders (TMD). For each patient, the angle of the condylar path, incisal guidance angle (IGA), interincisal angle, as well as overbite and overjet were measured on cone beam computed tomography (CBCT). This was followed by the examination with the Modjaw® electronic axiograph recording and calculating the functional sagittal condylar guidance angle (SCGA) for the right and left TMJ during the protrusion. The results show that the mean functional axiographic measurement of SCGA in protrusion significantly correlates with the TMJ anatomy presented on CBCT. Moreover, a significant correlation was found between the values of SCGA in the functional and anatomical measurements in all its variants. It turned out that, statistically, the AB measurement was the most accurate. Finally, results showed that incisal relationships of permanent teeth such as overbite, overjet, incisal guidance angle and interincisal angle do not correlate with TMJ anatomy, and therefore, regarding an analyzed study group, do not affect the TMJ formation in young adults.

/pdf/complicated-relationships-between-anterior-and-condylar-3aofv340.pdf

Complicated Relationships between Anterior and Condylar Guidance and Their Clinical Implications—Comparison by Cone Beam Computed Tomography and Electronic Axiography—An Observational Cohort Cross-Sectional Study

The purpose of this study was to investigate the condylar morphology and position of Koreans using cone-beam computed tomography (CBCT) images. Analyzing the mean values of this study with reference to left and right sides, gender, and age will help to understand the size of the condyle and glenoid fossa, condylar morphology, and temporomandibular joint (TMJ) symmetry for establishing the standard temporomandibular joint structures of Koreans and then design the standard temporomandibular joint prosthesis for Koreans. There was no significant result in the condyle size, condyle axis angle, joint space, fossa depth, and mandibular body size between the left and right sides (p > 0.05). On the other hand, the mediolateral width of the condyle and mandibular body size show significantly different with the gender (P < 0.05). Also, significant differences were found in condyle size, joint space, fossa depth, and mandibular body size according to age groups (p < 0.05). Condylar position and morphology vary according to side, age, and gender. The results of this study are expected to help in customizing a treatment for the patients who need TMJ reconstruction by predicting the TMJ morphology according to age and gender and design the standard temporomandibular joint prosthesis for the Koreans.

/pdf/temporomandibular-joint-morphology-in-korean-using-cone-beam-550nwzt4bq.pdf

Temporomandibular joint morphology in Korean using cone-beam computed tomography: influence of age and gender.

Background The authors evaluated the morphology and symmetry of the temporomandibular joint in participants with normodivergent and hyperdivergent skeletal class I, II, and III patterns. Methods A total of 80 participants were divided into 4 groups on the basis of their sagittal and vertical skeletal patterns. Cone-beam computed tomographic images were used to evaluate the condyle-fossa relationship and the morphology and symmetry of the mandibular condyle. One-way analysis of variance and Tukey post hoc tests were used to compare the mean values among the different groups. Results Participants with class II hyperdivergent patterns had the smallest anteroposterior (mean [standard deviation {SD}], 4.4 [1.6] millimeters) and mediolateral (10.5 [3.0] mm) condylar process widths among all 4 groups. The mean (SD) axial condylar angle was flatter in patients with class III hyperdivergent patterns (19.8° [5.1°]) compared with the other groups. The mean (SD) anteroposterior differences of the condylar processes (2.9 [1.4] mm) in patients with class III hyperdivergent patterns were the greatest in all 4 groups. Conclusion Participants in the group with class II hyperdivergent patterns have a smaller and narrower condyle compared with the other groups measured. Asymmetry was found among all groups, with participants with skeletal class III patterns having the most asymmetry. The most common condylar morphology in all groups examined was convex. Practical Implications These results support the concept that morphology and symmetry of the temporomandibular joint varies in different skeletal patterns, presumably as an adaptive response to functional demands.

Temporomandibular condylar morphology in diverse maxillary-mandibular skeletal patterns: A 3-dimensional cone-beam computed tomography study.

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Temporomandibular condylar morphology in diverse maxillary-mandibular skeletal patterns: A 3-dimensional cone-beam computed tomography study.