Is there an association between rheumatoid arthritis and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography? A systematic review and meta-analysis.

OBJECTIVES: Evaluate the relation of rheumatoid arthritis (RA) and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This systematic review and meta-analysis were recorded in the PROSPERO database, using the CRD42020153246 protocol. The electronic searches were performed in the following databases: Pubmed, Scopus, Web of Science, Lilacs, Cochrane, and Open Grey. Cross-sectional studies that evaluated patients with RA with bone changes in the temporomandibular joint diagnosed by CBCT, without language restriction or publication date, were included. Meta-analysis was performed in Stata Software (StataCorp, TX, USA, version 12.0), using the metan, and a random effects model, and the risk of different bone alterations occurring in adults with and without arthritis was estimated using odds ratios (ORs) as a pooled measure of effect. Forest plots were used to present the isolated and the pooled effects (ORs and 95% CI). RESULTS: Six studies were used for qualitative synthesis and 2 studies for quantitative synthesis. All studies diagnosed higher prevalence changes in the bone structures of the TMJ of RA patients, described as erosion, flattening, sclerosis, and osteophytes. Meta-analysis showed that the chance of bone changes occurring in components of the TMJ is greater in individuals who have RA. CONCLUSION: There is an association between RA and bone changes in TMJ structures diagnosed through CBCT, as RA patients were more likely to have osteoarthritic changes in this joint. CLINICAL RELEVANCE: Understanding the existence of an association between bone alterations in TMJ and RA can assist in the management of patients.

Impact of Image Filters and Observations Parameters in CBCT for Identification of Mandibular Osteolytic Lesions.

The aim of this study was to analyze the influence of filters (algorithms) to improve the image of Cone Beam Computed Tomography (CBCT) in diagnosis of osteolytic lesions of the mandible, in order to establish the protocols for viewing images more suitable for CBCT diagnostics. 15 dry mandibles in which perforations were performed, simulating lesions, were submitted to CBCT examination. Two examiners analyzed the images, using filters to improve image Hard, Normal, and Very Sharp, contained in the iCAT Vision software, and protocols for assessment: axial; sagittal and coronal; and axial, sagittal and coronal planes simultaneously (MPR), on two occasions. The sensitivity and specificity (validity) of the cone beam computed tomography (CBCT) have been demonstrated as the values achieved were above 75% for sensitivity and above 85% for specificity, reaching around 95.5% of sensitivity and 99% of specificity when we used the appropriate observation protocol. It was concluded that the use of filters (algorithms) to improve the CBCT image influences the diagnosis, due to the fact that all measured values were correspondingly higher when it was used the filter Very Sharp, which justifies its use for clinical activities, followed by Hard and Normal filters, in order of decreasing values.

Bifid mandibular condyle: case report and etiological considerations.

Bifid mandibular condyle, usually diagnosed on routine radiographic examination, is described in the literature as a rare entity. Its cause is controversial, and it has no predilection by sex or ethnic background. Dental professionals should have some knowledge of this anatomic abnormality, as well as its implications for function and appropriate treatment modalities, so that they can be alert to this potential diagnosis. This paper reports an unusual case of bifid mandibular condyle with possible traumatic cause, with emphasis on the radiographic and tomographic findings.