MRI assessment of temporomandibular disorders: an approach to diagnostic and therapeutic setting.

AIMS: The aim of this study was to evaluate the relationship between the clinical and the radiological data obtained by magnetic resonance imaging (MRI) in patients with temporomandibular disorder (TMD). METHODOLOGY: The study group included 17 patients with symptoms of TMDs. The radiological assessments before and after therapy was evaluated by MRI; in the clinical analysis, signs and associated symptoms have been assessed. RESULTS: With MRI before therapy, we were able to distinguish the specific type of TMD that each patient had. At the end of the treatment, a general improvement of the clinical status was noticed; MRI, however, showed the permanence of several degrees of condyle-disc incoordination in some patients. CONCLUSIONS: Certainly TMDs can be diagnosed without MRI; nevertheless, MRI gives us the possibility to obtain objective data of the patients concerned. Symptoms recorded during a clinical evaluation cannot be the only terms of diagnosis; MRI provides objective data in the diagnostic and post-therapy phases.

Interobserver variability of dynamic MR imaging of the temporomandibular joint.

PURPOSE: This study investigated the interobserver variability of dynamic magnetic resonance (MR) imaging of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Sixty-two patients with internal derangement of the TMJ (124 TMJs) were investigated with a 1.5-T MR imaging system during physiological opening and closing of the mouth. Two readers evaluated independently the quality of the dynamic examination (Q: nondiagnostic, diagnostic, optimal), condylar motion (CM: limited, suboptimal, optimal), condylar orientation (CO: in-plane, through-plane shift), disc visibility and movement (DV: visible, nonvisible; DM: normal, reducing, nonreducing dislocation) and joint effusion (JE: present, absent). For each TMJ, the condylar path was measured by tracing the position of the condyle in the frames of the dynamic acquisition. Agreement between the two readers was assessed with Cohen's Kappa and the Bland-Altman method. RESULTS: Interobserver agreement was almost perfect for Q (nondiagnostic, diagnostic, optimal: 0.8%, 4.9%, 94.3%; κ=1), CM (limited, suboptimal, optimal: 14%, 26.4%, 59.5%; κ=0.84) and DV (visible, nonvisible: 100%, 0%). Substantial agreement was found for DM (normal, reducing, nonreducing: 66.1%, 14.8%, 19.1%; κ=0.64) and JE (present, absent: 41.3%, 58.7%; κ=0.67). Moderate agreement was found for CO (in-plane, through-plane shift: 94.2%, 5.8%; κ=0.41). As for the condylar path, the means of the percentage differences and limits of agreement (LA) were -3% (LA: -34.5%, 28.3%) on the right and -1.2% (LA: -35%, 32.6%) on the left. CONCLUSIONS: In dynamic imaging of the TMJ, qualitative assessment of condyle-disc movement and joint effusion is minimally dependent on the reader's evaluation. Measurement of the condylar pathway shows an interobserver variability of ±30%.

[Neuromuscular occlusion in the orthodontic treatment of craniomandibular disorders. A clinical case]. / L'occlusione neuromuscolare nella terapia ortodontica del paziente con disordini craniomandibolari. Caso clinico.

In the last few years, it has been observed a considerable increase of cranio-mandibular disorders which presently represent one of the most common commitments for dentists and, in particular, for orthodontists. The aim of this paper is to evaluate the efficacy of Jankelson's therapeutic protocol, followed by an orthodontic treatment, in a patient with cranio-mandibular disorders associated with occlusal pathologies. The cranio-mandibular electromyography and kinesiography promoted by Jankelson provide objective diagnostic measurements, while tens, relaxing masticatory muscles, allows a correct recording of myocentric occlusion. In this case, the authors utilise these devices, according to a well established diagnostic and therapeutic protocol. The first step is purely gnatologic, and consists of the application of an orthotic to temporarily treat pain and dysfunction. The following phase is a simple orthodontic treatment representing the final therapy. Orthodontic and/or prosthodontic rehabilitation of dentition, in fact, is the ultimate step of the therapeutic scheme which allows long-lasting RESULTS.