Assessment of the Morphology and Degenerative Changes in the Temporomandibular Joint Using CBCT according to the Orthodontic Approach: A Scoping Review

Abstract

Background. Available knowledge about disorders of temporomandibular joint structures and their association with orthodontic variables are still lacking. Objectives. This article is aimed at to identifying studies and presenting current information on the relationship between morphology diversity and the occurrence of degenerative changes in structures of the temporomandibular joint (TMJ) assessed by cone-beam computed tomography (CBCT) in the context of craniofacial morphology and malocclusion. Search Methods. The review was conducted by analyzing the PubMed (including Medline), Cochrane Library, Web of Science, and Scopus electronic databases up to November 2021 using two different comprehensive search strategies based on keywords as well as additional manual searches. Eligibility Criteria. Selection of the literature was carried out according to the PRISMA-ScR checklist. Methodological quality of the selected studies was evaluated using JBI Critical Appraisal Tool. Results. The electronic databases search revealed 3331 records. After applying the eligibility criteria and JBI assessment, a total of 33 studies were extracted and selected to the study. The review was divided into 4 parts, in which the following correlations were assessed in terms of orthodontic variables: TMJ degenerative changes, joint space and condylar position, condylar shape, TMJ articular eminence, and fossa. Conclusions. Skeletal and dental class II malocclusion with a retrognathic mandible, a hypodivergent skeletal pattern with a steep mandibular plane, and significant lateral mandibular displacement can be risk factors for developing radiographically detectable degenerative changes. Patients with skeletal and dental class III malocclusion as well as a hyperdivergent skeletal pattern may be at greater risk of TMD occurrence compared with other groups. Further studies are necessary to clarify the relationship between the position of the condylar processes and the presence of degenerative changes in the temporomandibular joints among orthodontic patients.

The Role of Maxillofacial Structure and Malocclusion on Condylar Displacement in Maximum Intercuspation and Centric Relation in Patients Seeking Orthodontic Treatment—A Scoping Review

“…Based on the above studies, an orthodontist can predict a greater CD in patients with a hyperdivergent face type, especially in the vertical dimension. This observation confirms the theory that hyperdivergent patients present with a higher risk of TMD development [ 70 ].…”

“…A study by Ari-Demirkaya et al [ 65 ] did not show any significant differences in the direction of the condyle in the sagittal plane between the groups. Assessment of the condyle position by CBCT also showed a great variety in hypodivergent patients and the position of the condyle in hyperdivergent patients being more predictable [ 70 ].…”

What factors predict craniomandibular disorders in severe COVID-19 survivors after prolonged intubation?

“…Concerning the facial form, approximately one-third of skeletal class II patients have myofascial pain, and these patients with myofascial pain have more risks of TMJ disc displacement, pain, depression, and polymorphisms of dopamine receptors DRD2 ( rs6275 and re6276 , indicating pain-related depression) [28] . Meta-analyses pointed out that class II malocclusion with a retrognathic mandible as well as hypodivergent faces with a steep dental occlusal plane were risk factors for degenerative changes of the TMJ [ 29 , 30 ]. After functional mandibular advancement with orthodontic appliances, CMD symptoms often disappear [31] .…”

Radiology of Tempromandibular Joint After the Orthodontic Treatment

“…The technical advantages of CBCT include the following characteristics: high quality of images in the bone mode, the possibility of building multiplanar and 3D reconstructions, relatively low radiation exposure and examination time compared to MSCT, convenient (more often in a sitting or standing position) patient positioning, many additional applications and programs for planning and virtual simulation of various types of surgical treatment. The limitation of the method is the almost complete absence of soft tissue differentiation, which results in difficult visualization of soft tissue density structures [19,20].…”

“…make an accurate diagnosis and to more effectively plan treatment prior to surgery. Multispiral computed tomography (MSCT) is a layerby-layer X-ray examination with computer reconstruction of the image with a spiral trajectory of rotation of the "X-ray tube-detector" system around the object being examined [17,18,20]. Due to the increase in the number of detector rows, modern tomographs have the ability to obtain several sections simultaneously, which makes it possible to obtain high-quality images of the area under study, reduce examination time and reduce radiation exposure.…”