An assessment of the accuracy of a panoramic radiograph as compared with cone-beam tomography in TMJ imaging

Abstract

The articular disc of the temporomandibular joint (TMJ) cannot be seen on plain x-ray examination but an accurate assessment of the space between the glenoid fossa and the head of the condyle may provide the clinician with a clue to a possible pathological problem. Measurements of the TMJ space seen on panoramic radiographs (PAN) and on cone beam computerised tomographic scans (CBCT) were carried out on films taken of of left and right TMJs of forty-six patients. On each image a vertical line was drawn digitally from the highest point of the condylar head to the glenoid fossa of the temporal bone. The lengths of the lines were recorded on Galileo software and compared using the Bland-Altman statistical test (total sample size 92 joints). Bias was achieved at mean differences of 1.03mm with a p-value of <0.001 which was statistically significant. Left and right TMJ mean values showed a 0.09 mm difference. Age was insignificant at p=0.40. The Levels of Agreement indicated workable concord between the methods although a wide range was evident.

Joint space measurement in centric occlusion between panoramic temporomandibular joint radiography and cone-beam computed tomography: a comparison in patients with clicking disorders

“…Retro-discal tissue helps the disc stay in its position between the joint bone structures [5]. By measuring the anterior, superior, and posterior joint spaces, the ideal position of the mandi- bular condyle adjacent to the glenoid fossa can be determined [3,9]. Panoramic radiography is the basis of dental radiology examination, and CBCT can be used in complex cases; both are options for evaluating osseous structures in the TMJ area [5,12].…”

“…TMJ maneuvers for masticatory movements involve a combination of neurological and muscle control. Therefore, if there is a movement dysfunction, it will cause a temporomandibular disorder (TMD) [3]. TMJ dysfunction is one of the possible causes of TMD.…”

“…Several studies on condyle-fossa position were quantitatively assessed on CBCT in both normal and TMD participants [2,8,9]. Soni and Buch [3] analyzed the superior joint space between CBCT and panoramic radiograph in patients without TMJ disorders randomly selected from the radio logy database.…”

“…Panoramic radiography has the potential to detect abnormalities in TMJ, and this has been investigated in few studies on joint space. Also, panoramic is widely used to help diagnose TMJ abnormalities through joint space analysis due to its low cost and accessibility [3]. Although CBCT has several advantages, main drawbacks include its availability in major cities only, especially in Indonesia, and higher examination cost compared with panoramic radiograph.…”

Morphological Appearance of Condylar Head in Mixed Dentition Period (Evaluated from Panoramic Radiograph)

“…Panoramic radiograph or as known as Orthopantomogram (OPG), presents single tomographic image of facial structures that includes maxillary and mandibular arch and adjacent anatomical structures such as temporomandibular joint [12]. Panoramic imaging provides essential data that can be useful for early diagnosis of TMDs as it presents a two-dimension anatomical image of condylar process and glenoid fossa that acts as important parts in temporomandibular joint [13].…”