Cone beam computed tomography as diagnostic modality in temporomandibular disorders: A report of four cases

Abstract

A considerable number of people suffer from temporomandibular joint (TMJ) disorders. Detailed history and clinical examination are essential for diagnosing TMJ disorders. Diagnosis of temporomandibular disorder (TMD) is based on clinical and radiographic investigations, where the latter is an important part of the clinical diagnosis. There are varieties of imaging techniques modalities to visualize TMJ ranging that include TMJ projections such as transpharyngeal view, transcranial view, orthopantomography, and conventional tomographic sections of TMJ. The TMJ disorders are frequently associated with degenerative bone changes such as flattening, erosion, osteophytes, subchondral bone sclerosis, pseudophytes, and articular eminence pneumatization which can be challenging to detect on conventional radiographs. Due to superimposition of the anatomic structures, accurate evaluation of the TMJ by conventional radiography is limited. To overcome this limitation, advanced modalities such as magnetic resonance imaging, arthrography and conventional computed tomography (CT) have been used for TMJ imaging for evaluating the joint space and the position of the condyle within the glenoid fossa. Accurate evaluation of the TMJ by conventional radiography is limited by structure superimposition. CT has been extensively used and proven imaging modality to assess the contours of the cortical bone and TMJ dynamics for evaluating the osseous changes in TMJ; however, high cost, large radiation dose, and long scanning time pose severe limitations. Due to high spatial resolution characteristics along with comparatively low dose, cone beam CT (CBCT) is an emerging technique that is being widely used in maxillofacial imaging. It is superior to conventional radiographic techniques in detecting bony TMJ changes because it detects three-dimensionally the bony structures with accuracy and involves a very slight increase in dosage of radiation when compared with the newer digital panoramic imaging and cephalometric imaging. Hence, a study of 4 cases of TMJ disorders that have been diagnosed with the help of CBCT has been presented in this article.