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 Table of Contents  
Year : 2015  |  Volume : 27  |  Issue : 1  |  Page : 81-84

Comparison of the diagnostic accuracy of CBCT and conventional CT in detecting degenerative osseous changes of the TMJ: A systematic review

Department of Oral Medicine and Radiology, Saveetha Dental College, Chennai, Tamil Nadu, India

Date of Submission24-Sep-2014
Date of Acceptance31-Jul-2015
Date of Web Publication12-Oct-2015

Correspondence Address:
Ranjeni Rajamani Veerappan
Saveetha Dental College, Chennai - 600 077, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-1363.167090

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Temporomandibular joint (TMJ) disorders are a group of conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement. According to the Research Diagnostic Criteria (RDC/TMD), temporomandibular disorders (TMDs) may be classified into three different groups: a) myofacial pain dysfunction syndrome (MPDS), b) internal derangement, and c) arthritis. Complicated anatomy of the TMJ was the reason for developing standardized radiographic techniques to diagnose TMDs. The introduction of computed tomography (CT) in the diagnosis of TMJ disorders enabled much better delineation of anatomical structures of the joint due to lack of tissue superposition. Cone beam CT (CBCT) is the latest imaging modality for craniofacial deformities, with a lesser radiation exposure and cheaper cost when compared to CT. A systematic literature search was done to identify articles describing degenerative osseous changes of the TMJ using CBCT and conventional CT. Electronic search of scientific papers was carried out in PubMed (MeSH), ScienceDirect, and Cochrane databases using specific keywords. In this systematic review, all the selected articles demonstrate the role of CBCT and CT in diagnosing the degenerative osseous changes of the TMJ. The studies included in the review suggested that CT has been the method of choice to assess the TMJ dynamics and contours of the cortical bone.

Keywords: Computed tomography, cone beam computed tomography, conventional computed tomography, degenerative arthritis, temporomandibular joint degenerative disease, temporomandibular joint disorder

How to cite this article:
Veerappan RR, Gopal M. Comparison of the diagnostic accuracy of CBCT and conventional CT in detecting degenerative osseous changes of the TMJ: A systematic review. J Indian Acad Oral Med Radiol 2015;27:81-4

How to cite this URL:
Veerappan RR, Gopal M. Comparison of the diagnostic accuracy of CBCT and conventional CT in detecting degenerative osseous changes of the TMJ: A systematic review. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2022 Oct 3];27:81-4. Available from: https://www.jiaomr.in/text.asp?2015/27/1/81/167090

   Introduction Top

Temporomandibular disorder (TMD) is a condition affecting the temporomandibular joints (TMJs) with pain and dysfunction of the muscles of mastication and also other osseous changes. The most important feature is pain, followed by restricted mandibular movement and noises from the TMJ. Although TMD is not life threatening, the main concern is that it can detriment the quality of life, because the symptoms can become chronic and difficult to manage. Complex etiologic factors like trauma, emotional stress, orthopedic instability, muscular hyperactivity, inflammatory and degenerative diseases, which compromise the equilibrium of the TMJ, have been implicated in the development of TMDs. Various diagnostic systems have been described to classify TMDs. Some consider the Research Diagnostic Criteria method as the gold standard. Abbreviated as "RDC/TMD," this was first introduced in 1992 by Dworkin and LeResche in an attempt to classify TMDs by etiology and apply the universal standards for research into TMD:

  1. Myofacial pain dysfunction syndrome (MPDS),
  2. Internal derangement,
  3. Arthritic conditions of TMJ. [1],[2]

Arthritis is a degenerative condition of the joint, associated with either overuse of the joints or aging, or it can occur as an autoimmune disease. Rheumatoid arthritis is a chronic inflammation of the synovial membrane with pain in the muscles and joints. A degeneration or "wear and tear" of articular (joint surface) cartilage is usually accompanied by an overgrowth of bone (osteophytes), narrowing of the joint space, sclerosis or hardening of bone at the joint surface, and deformity in joints. This type of arthritis is called osteoarthritis (OA). Osteoarthritis is not usually associated with inflammation, although swelling of the joint does frequently occur in OA. The patient will often hear clicking and popping noises or grinding in the joint, and may feel roughness or grating. Joint noise indicates that the cartilage and the disk are beginning to lose their normal smooth contour. Pain in the joint often indicates progression of the disease leading to destruction of the joint components. When the degenerative conditions involve the osseous structures in case of autoimmune arthritis, there is destruction of the bony components in the form of erosions, flattening of the condylar head, flattening of the articular eminence, sclerosis, and osteophytes or pseudocysts.

Radiological investigations are of paramount importance in the diagnostic assessment of a patient with TMD. The American Academy of Oral and Maxillofacial Radiology (AAOMR) has established the rationale for image selection for diagnosis, treatment planning, and follow-up of a patient with conditions affecting the TMJ. Conventional radiographic TMJ projections like transpharyngeal, transcranial, panoramic radiograph, and conventional tomographic sections of TMJ may be adequate in a number of clinical situations. But there are bony alterations that occur in these disorders, such as erosions, osteophytes, flattening, sclerosis, pseudocysts, and pneumatization of articular eminence that are difficult to be detected in conventional radiographs due to overlapping of the anatomic structures. [3] This warrants the use of advanced imaging modalities like magnetic resonance imaging (MRI), arthrography, conventional computed tomography (CT), and cone beam computed tomography (CBCT). Cone beam computed tomography is a dental imaging technique in which a cone-shaped X-ray beam centered on a two-dimensional (2D) detector produces a series of 2D images. For assessment of bone detail, CT scanning is a superior imaging method. Multiplanar reconstructions allow superior morphologic analyses of the osseous joint structures. Conventional tomography is a more sophisticated digital tomographic technique where the patient is exposed to a fan-shaped X-ray beam directed to a series of detectors. The detectors and/or the X-ray beam move around the patient, usually in the axial plane, to acquire numerous projections at various angles. The transmission data from these projections are used to reconstruct the image, which is viewed on a computer monitor.

   Methodology Top

A systematic literature search was done to compare the diagnostic accuracy of CBCT and conventional CT in detecting degenerative osseous changes of the TMJ. Electronic search of scientific papers was carried out in PubMed (MeSH), ScienceDirect, and Cochrane databases using specific keywords. A total of 2396 articles were found. PubMed search yielded 124 papers, ScienceDirect search yielded 0 papers, and Cochrane search yielded 0 papers. Hand search for relevant articles also yielded 0 papers. Of the 122 articles that were excluded, some were found to be irrelevant based on the title and abstract and some were excluded based on the inclusion and exclusion criteria. Two articles were finally selected that formed the basis for this review. Comparative studies demonstrating the degenerative osseous changes of the TMJ using CBCT and conventional CT were considered. Studies carried out on human skulls and autopsy materials only were included. Studies pertaining to assessing other TMJ disorders like MPDS and internal derangement were excluded. Studies containing radiological comparison correlating with other histological, biochemical, and pain-related studies were also excluded.

   Results Top

The search methodology used in this review yielded 124 publications of which 2 articles were included and the remaining 122 articles were excluded from the review [Table 1] and [Table 2]. The summation of individual parameters and general information of the selected articles are tabulated based on CBCT and conventional CT interpretation of various degenerative osseous changes seen in the TMJs. The various osseous changes that are detected in the TMJ are erosions of the mandibular condyle, erosions of the articular eminence, flattening of the condylar head, sclerosis, osteophyte formation, and pseudocysts. [4],[5],[6] Charts 1 and 2 represent the specificity and sensitivity of the selected articles that have been reviewed.
Table 1: Summation table for individual parameters

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Table 2: General information table

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   Discussion Top

The dental practitioner sees a large number of patients with TMDs. Temporomandibular disorders refer to a group of disorders characterized by pain and tenderness in the TMJ, or the masticatory muscles, with limitation or deviated mouth opening and clicking sounds heard in the TMJ during mandibular function with pain in adjacent structures, and these do not interfere with growth or development and are not related to systemic diseases. Among the TMDs, degenerative disorders like OA and rheumatoid arthritis result in pain and limitation of jaw movement. The most recent imaging modality for the dentofacial structures is the CBCT, which is designed specifically for dental use and has become widely acceptable and available. The major advantages of CBCT include low radiation dose and high spatial resolution due to its minute voxels. Honda et al. compared the diagnostic accuracy of CBCT with that of multidetector computed tomography (MDCT) in detecting osseous abnormalities of the TMJ, and concluded that CBCT was similar to MDCT and that both modalities were highly reliable. [7] The search methodology used in this review revealed 124 publications of which 2 articles were relevant. The remaining 122 articles were excluded from the review. The two articles were finally included for the review. Different studies in our systematic review suggest various imaging modalities for examination of the degenerative bone changes that are seen in the TMJ. The main imaging modalities for the TMJ that have been discussed in this review are CBCT and conventional CT. Out of 124 studies, 2 studies showed comparison of conventional CT and CBCT in their application to detect various degenerative osseous changes of the TMJ of human skulls and autopsy materials. Among the 124 articles, in 1 article, dos Anjos Pontual et al.[1] stated that the sample selected for their study was representative and showed prevalence of bone changes (71%) with CBCT, which was similar to the study conducted by Koyama et al. who verified 63.7% of the joints of patients with TMDs using CT. All the selected articles demonstrate the role of CBCT and CT in diagnosing the degenerative osseous changes of the TMJ. [8],[9],[10],[11] In the two articles, the levels of osseous changes demonstrated on CBCT, such as osteophyte formation, pseudocysts, flattening of the condylar head and articular eminence, erosions of the condylar head, and sclerosis, have been compared with those seen in conventional CT. [6]

   Conclusion Top

Although significant correlation has been found between both the imaging modalities, the review also reveals that TMJ as a whole and, particularly, the diseased osseous components due to degenerative diseases can be clearly interpreted in a conventional CT in spite of the fact that there is excess radiation exposure in CT and it is an expensive technique. Thus, through this systematic review, it has been concluded that CT would be the most appropriate in diagnosing degenerative osseous changes of the TMJ.

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Conflicts of interest

There are no conflicts of interest.

   References Top

dos Anjos Pontual ML, Freire JS, Barbosa JM, Frazão MA, dos Anjos Pontual A. Evaluation of bone changes in the temporomandibular joint using cone beam CT. Dentomaxillofac Radiolo 2012;41:24-9.  Back to cited text no. 1
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: A systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112: 453-62.  Back to cited text no. 2
Krishnamoorthy B, Mamatha N, Kumar VA. TMJ imaging by CBCT: Current scenario. Ann Maxillofac Surg 2013;3:80-3.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc 2006;72:75-80.  Back to cited text no. 4
Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol 2009;38:141-7.  Back to cited text no. 5
Zain-Alabdeen EH, Alsadhan RI. A comparative study of accuracy of detection of surface osseous changes in the temporomandibular joint using multidetector CT and cone beam CT. Dentomaxillofac Radiol 2012;41:185-91.  Back to cited text no. 6
Honda K, Larheim TA, Maruhashi K, Matsumoto K, Iwai K. Osseous abnormalities of the mandibular condyle: Diagnostic reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material. Dentomaxillofac Radiol 2006;35:152-7.  Back to cited text no. 7
Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Dent Clin North Am 2013;57:405-18.  Back to cited text no. 8
Petersson A. What you can and cannot see in TMJ imaging - An overview related to the RDC⁄TMD diagnostic system. J Oral Rehabil 2010;37:771-8.  Back to cited text no. 9
Cevidanes LH, Hajati AK, Paniagua B, Lim PF, Walker DG, Palconet G, et alQuantification of condylar resorption in temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:110-7.  Back to cited text no. 10
Tsiklakis K, Syriopoulos K, Stamatakis HC. Radiographic examination of the temporomandibular joint using cone beam computed tomography. Dentomaxillofac Radiol 2004;33: 196-201.  Back to cited text no. 11


  [Table 1], [Table 2]


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