Lipski, Marcin

Loster, Bartłomiej

Pełka, Piotr

Williams, Stephen

English

Jagiellonian Univeristy Repository

FOLIA MEDICA CRACOVIENSIAVol. LVI, 4, 2016: 43–50PL ISSN 0015-5616Quantitation of condylar position in temporomandibular joint.A methodological studyPiotr Pełka1, Stephen Williams1, Marcin Lipski2, Bartłomiej W. Loster11Department of Orthodontics, Dental Institute, Faculty of Medicine, Jagiellonian University Medical Collegeul. Montelupich 4/108, 31-155 Kraków, Poland2Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical Collegeul. Kopernika 12, 31-034 Kraków, PolandCorresponding author: Piotr Pełka, Department of Orthodontics, Dental Institute, Faculty of Medicine, Jagiellonian University Medical College, ul. Montelupich 4/108, 31-155 Kraków, PolandE-mail: p.pelka@uj.edu.plAbstract: Ten CBCT scans of asymptomatic patients were evaluated on sagittal slices to obtain con-dylar position in temporomandibular joint. Measurements focused on antero-posterior and su-perior-inferior position of the condyle. Th e study the study was performed to investigate repro-ducibility of the method described before using Dahlberg formula. Th e method seems to be fair reproducible.Key words: reproducibility, condyle, temporomandibular joint.IntroductionMorphology of temporomandibular joint and relations between condyle and fossa have been investigated by many observers and diff erent methods have been used according to imaging methods available at the time particular research was provided. 44 Piotr Pełka, Stephen Williams, et al.Early studies performed by Gillis [1] and Reisner [2] used cephalograms. Mandibular condyle is a  double structure [3] and forms temporomandibular joint with glenoid fossa of temporal bone. Th e picture of temporomandibulr joint on lateral cephalogram is not clear because petrosus part of temporal bone superimposes the joint structures. Th e use of angular radiograms created distortion of picture, which might infl uence the results. R.M. Ricketts [4] used laminagraphy to picture the joint structures. Th e method was introduced by Pacini in 1922. Laminography anabled the visualisation of selected plane of the body to the exclusion of other planes. He measured condylar position in by three distances: (1) between most anterior point of the condyle and posterior surface of the tuberculum articulare, (2) highest point of the condyle and deepest point of the fossa and (3) most posterior point of the condyle and middle of the meatus. His results were that condyle is positioned not in the centre of the fossae but superiorly and anteriorly in the fossa. Laminography was also used by Broadbend [5] and Brader [6] in their growth studies.Recent method of examining temporomandibular joint is cone beam computed tomography (CBCT) introduced in 1996 which is a  three-dimentional scan of anatomical structures and any plane can be chosen to be examined or measured [7]. Rodrigues et al. [8] they used the shortest distances between anterior point of the condyle and articular eminence, highest point of the condyle to the deepest point in the fossa and most posterior point of the condyle and posterior wall of the fossa to describe antero-posterior position of the condyle.The aim of the present pilot study was to evaluate reprodusibility, repetibil-ity of  method of describing condylar position in the fossa, presented by Rod-rigues et al. [8].Material and methodTh e material of the present study was based on 10 CBCT scans of orthodontic patients taken for other reasons. Mean age was 19.1, maximum age was 36, minimum age was 13 years. 9 of the patients were female, 1 patient was male. Th e patients did not present any symptomatic temporomandibular disorders or pain. The evaluation was performed by calibrated independent observer (PP) both right and left  TMJ for each CBCT scan. All measurements were performed twice at separate sessions at least 2 weeks apart. Th e CBCT scans were evaluated on Osirix soft ware. Th ree mesurements were provided for each condyle as described:1.  anterior joint space: expressed by the shortest distance between the most anterior point of the condyle and the posterior wall of the articular tubercle (Fig. 1 — a) Quantitation of condylar position in temporomandibular joint. A methodological study 452.  superior joint space: measured from the shortest distance between the most superior point of the condyle and the most superior point of the mandibular fossa (Fig. 1 — s)3.  posterior joint space: represented by the shortest distance between the most posterior point of the condyle and the posterior wall of the mandibular fossa (Fig. 1 — p)Fig. 1Th e measurements were determined in the CBCT scan viewer using measuring tool. All distances were expressed in milimeters. Th e measurement slice was found as described by authors of the method.Measurements 1 and 2 of anterior, superior and posterior space were compared to fi nd the diff erences between left  and right condyle position.Statistical analysisReproducibility of the measuring method was evaluated by using Dahlberg formula [9].ResultsTh e results show that distances of AS, SS and PS on the right site ranged 1.5–4.2; 1.3–3.3; 0.6–7.2 and on the left  site ranged 1.4–3.8; 0.9–5.0; 0.6–6.9 respectively (Table 1).46 Piotr Pełka, Stephen Williams, et al.Table 1.PatientAssessement 1 Assessement 2LEFT RIGHT LEFT RIGHTAS SS PS AS SS PS AS SS PS AS SS PS 1. 1.9 2.5 3.8 1.8 1.7 2.1 2.2 2.4 3.1 2.0 1.9 2.1 2. 2.2 3.2 2.4 2.3 2.5 2.7 2.1 3.2 2.2 2.2 3.0 2.7 3. 1.4 1.2 1.6 2.1 1.3 0.6 1.3 1.3 1.3 1.4 1.3 0.4 4. 2.4 0.9 3.4 4.2 1.6 0.7 1.8 1.1 3.3 4.4 1.8 0.8 5. 2.3 1.8 2.2 2.3 1.4 2.9 2.3 2.4 2.3 2.2 1.7 2.8 6. 2.7 1.6 6.9 2.3 2.4 7.2 2.1 2.2 7.0 2.3 2.1 7.2 7. 2.1 5.0 3.9 1.5 2.7 2.8 1.9 5.2 3.9 1.6 3.0 3.5 8. 1.6 4.8 1.4 1.9 3.3 1.4 1.9 4.9 1.5 1.8 4.0 1.6 9. 2.2 3.2 0.6 1.6 1.4 3.4 2.4 2.4 0.9 2.2 2.8 2.410. 3.8 3.2 1.5 1.9 2.6 2.1 3.9 3.2 1.6 1.7 2.8 1.9Measurements 1 and 2 results in both right and left  condyle AS — anterior space, SS — superior space, PS — posterior space. Table 2.LEFT RIGHTAS Δ SS Δ PS Δ AS Δ SS Δ PS Δ 1. 0.3 0.1 0.7 0.2 0.2 0 2. 0.1 0 0.2 0.1 0.5 0 3. 0.1 0.1 0.3 0.7 0 0.2 4. 0.6 0.2 0.1 0.2 0.2 0.1 5. 0 0.6 0.1 0.1 0.3 0.1 6. 0.6 0.6 0.1 0 0.3 0 7. 0.2 0.2 0 0.1 0.3 0.7 8. 0.3 0.1 0.1 0.1 0.7 0.2 9. 0.2 0.8 0.3 0.6 1.4 110. 0.1 0 0.1 0.2 0.2 0.2D= 0.2247 0.2711 0.1949 0.2247 0.3931 0.2855Delta values of massessement 1 and 2. Dahlberg calculation results.  Quantitation of condylar position in temporomandibular joint. A methodological study 47Th e results show that delta values of assessments 1 and 2 for anterior space (AS), superior space (SS) and posterior space (PS) were 0–0.7; 0–1.4; 0–1.0 respectively. Delta values for 60 measured distances was calculated. 0–0.5 was presented by  49  assessments, 0.6–1.0 by 10 assessments and >1.0 by 1 assessement (Table 2, Fig. 2 a, b).Diff erence (delta values) of assessement 1 and 2 left  site0.90.80.70.60.50.40.30.20.10.0 a. Left  site. Y axis in mm.Diff erence (delta values) of assessement 1 and 2 right site1.61.41.21.00.80.60.40.20.0 b. Right site.Fig. 2.Dahlberg formula was calculated (ref) for error of measurement fi nding. Th e results on the right site were as follows: AS = 0.2247, SS = 0.3931, PS = 0.2855 and on the left  side: AS = 0.2247, SS = 0.2711, PS = 0.1949. Th e results were calculated with acuracy to 0.0001 (Table 2).48 Piotr Pełka, Stephen Williams, et al.Anterior space R/L – mean values a. ASSuperior space R/L – mean values b. SSPosterior space R/L – mean values c. PSFig. 3. Comparison of mean values of assessement 1 and 2 in right and left  condyle.5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Quantitation of condylar position in temporomandibular joint. A methodological study 49The results show that the range of anterior space (AS) was 1.4 to 3.8 in assessement 1 and 1.3 to 3.9 in assessement 2; superior space (SS) was 0.9–5.0 and 1.1–5.2; posterior space (PS) was 0.6–7.2 and 0.9–7.2. It was observed, that corresponding distances on the right and left site were diff erent in all patients (Fig. 3 a, b, c).DiscussionAlteration of occlusion as a  result of orthodontic treatment may influence temporomandibular joint and alter condylar position on the fossa [10, 11]. The method used in the study was CBCT. It allows to investigate bony structures but TMJ consists also ligaments and disc which structures are not visible on CBCT scan. Shape of the disc may influence three-dimensional position of the condyle in the fossa. And in patients presenting asymptomatic TMJ, condyle may be positioned anteriorly, posteriorly or in the centre of the fossa. It may also be diff erent on the right and left  site of the same patient as described in results of present study. ConclusionsTh e evaluation 1 and 2 showed minor diff erences and Dahlberg’s formula results were low which might indicate that the method may be used as fair and reproducible. Confl ict of interestNone declared.References 1.  Gillis R.: Roentgen Ray Study of the Temporomandibular Articulation. J Am Dent A. 1935; 22: 1321–1328. 2.  Reisner S.E.: Temporomandibular Reactions to Occlusal Anomalies. J Am Dent A. 1938–1953; 25: 1938. 3.  Lipski M., Tomaszewska I.M., Lipska W., Lis G.J., Tomaszewski K.A.: Th e mandible and its foramen: anatomy, anthropology, embryology and resulting clinical implications. Folia Morphol. 2013; 72 (4): 285–292. 4.  Ricketts R.M.: Variations of the temporomandibular joint as revealed by cephalometric laminagraphy. Am J Orthod. 1950; 36, 12: 877–898. 5.  Broadbent B., Holly: A New X-ray Technique and Its Spplication to Orthodontia, Angle Orthodontist. 1931; 1: 45–66. 6.  Brader A.C.: Th e Application of the Principles of Cephalometric Laminagraphy to the Studies of the Frontal Planes of the Human Head. Am J Orthod. 1949; 35: 249–268.50 Piotr Pełka, Stephen Williams, et al. 7.  Berghan S., Tetradis S., Mallya S.M.: Application of cone beam computed tomography for assessement of the temporomandibular joints. Aus Dent J. 2012; 57 (Suppl): 109–118. 8.  Rodrigues A.F., Fraga M.R., Vitral R.W.: Computed tomography evaluation of the temporomandibular joint in Class I  malocclusion patients: Condylar symmetry and condyle-fossa relationship. Am J Orthod. 2009; 136: 2: 199–206. 9.  Galvão M.C.S., Sato J.R., Coelho E.C.: Dahlberg formula — a  novel approach for its evaluation. Dental Press J Orthod. 2012 Jan–Feb; 17 (1): 115–124.10.  Pullinger A.G., Solberg W.K., Hotiender L., Petersson A.: Relationship of mandibular condylar position to dental occlusion factors in an asymptomatic population. Am J Orthod Dentofac Orthop. 1987; 91: 200–206.11. Weinberg L.A.: Role of condylar position in TMJ dysfunction-pain syndrome. J Prosthet Dent. 1979; 41: 636–643.

Quantitation of condylar position in temporomandibular joint : a methodological study

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Quantitation of condylar position in temporomandibular joint : a methodological study

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