BackgroundTo test clinical findings associated with early temporomandibular joint (TMJ) arthritis in comparison to the current gold standard contrast enhanced magnetic resonance imaging (MRI) in children with juvenile idiopathic arthritis (JIA).MethodsSeventy-six consecutive JIA patients were included in this study. Rheumatological and orthodontic examinations were performed blinded to MRI findings. Joint effusion and/or increased contrast enhancement of synovium or bone as well as TMJ deformity were assessed on MRI and compared to clinical findings. The maximal mouth opening capacity (MOC) of the JIA patients was compared to normative values obtained from a cohort of 20719 school children from Zürich, Switzerland.ResultsOn MRI a total of 54/76 (71 %) patients and 92/152 (61 %) joints had signs of TMJ involvement. MRI showed enhancement in 85/152 (56 %) and deformity in 39/152 (26 %) joints. MOC, asymmetry and restriction in condylar translation showed significant correlation to TMJ enhancement and deformity, whereas antegonial notching was correlated with TMJ deformity only. When joints with deformity were excluded, enhancement alone did not show a significant correlation with any clinical factor.ConclusionsClinical findings in affected TMJs are correlated with structural damage only. Therefore clinical assessment of TMJs does not allow to diagnose early arthritis accurately and will still depend on contrast enhanced MRI.

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All 3D imaging procedures yielded nearly equal results when used to measure the CondProc and RH. MRI is recommended because it avoids ionizing radiation and has higher sensitivity in the detection of inflammation. A 2-year threshold for detecting growth in the follow-up period should be taken into account for all 3D imaging methods. Measuring the RH is recommended for the follow-up of condylar growth because reference values for annual increments are published.

Objectives:The aim was to compare the accuracy of linear bone measurements of cone beam CT (CBCT) with multidetector CT (MDCT) and validate intraoral soft-tissue measurements in CBCT. Methods: Comparable views of CBCT and MDCT were obtained from eight intact cadaveric heads. The anatomical positions of the gingival margin and the buccal alveolar bone ridge were determined. Image measurements (CBCT/MDCT) were performed upon multiplanar reformatted data sets and compared with the anatomical measurements; the number of non-assessable sites (NASs) was evaluated. Results: Radiological measurements were accurate with a mean difference from anatomical measurements of 0.14 mm (CBCT) and 0.23 mm (MDCT). These differences were statistically not significant, but the limits of agreement for bone measurements were broader in MDCT (21.35 mm; 1.82 mm) than in CBCT (20.93 mm; 1.21 mm). The limits of agreement for softtissue measurements in CBCT were smaller (20.77 mm; 1.07 mm), indicating a slightly higher accuracy. More NASs occurred in MDCT (14.5%) than in CBCT (8.3%). Conclusions: CBCT is slightly more reliable for linear measurements than MDCT and less affected by metal artefacts. CBCT accuracy of linear intraoral soft-tissue measurements is similar to the accuracy of bone measurements.

A high prevalence of cervical vertebrae anomalies (CVA) has been recently associated with various malocclusions. Our aim was to study the prevalence of CVA on lateral cephalograms in Class II subjects and to compare the findings with those obtained from cone beam computed tomography (CBCT). Standardized cephalograms of 238 Class II patients were analysed for CVA. Cephalogram and CBCT were available for an additional 21 subjects. Cephalometric values were correlated with vertebrae morphology; logistic regressions and intraobserver agreement were evaluated. Inspection of lateral cephalograms could exclude CVA in 90.3 per cent of the subjects, while 9.7 per cent showed potential fusions. No correlations were found between the cephalometric values and potential vertebrae anomalies. In the 21 patients with a CBCT and a lateral cephalogram, the visual assessment of the cephalogram yielded a potential fusion in nine cases. None could be confirmed by CBCT. A low number of potentially fused cervical vertebrae could be detected on lateral cephalograms. The possible fusions did not correlate to any cephalometric values nor could they be confirmed by CBCT, the gold standard for assessing CVA. Visual examination of a cephalogram may result in a false-positive finding and does not allow reliable diagnosis of CVA.