Assessing Evaluating and Correlating the Clinical Findings of Temporomandibular Joint Pathology with Orthopantomogram and Magnetic Resonance Imaging – A Cross-Sectional Study

Abstract

Background: Because of the anatomic complexity of the temporomandibular joint (TMJ) clinician cannot arrive at the accurate diagnosis only by clinical evaluation of TMJ hence would require some special imaging methods and techniques which would facilitate the accurate clinical diagnosis. One such imaging method is orthopantomography (OPG) of TMJ. Even though OPG has various limitations, it provides valuable information of TMJ and seems to be the primary choice of imaging modality for the diagnosis of TMJ pathologies. Magnetic Resonance Imaging (MRI) is considered to be the one of the best imaging technology to assess the soft tissue structures surrounding the TMJ and evolved as the best imaging modality for the diagnosis of disc displacement of TMJ. Aim: The aim of the study is to evaluate the clinical findings of the TMJ pathologies and to compare the findings of the OPG and MRI of the TMJ pathologies. Methodology: This is a cross-sectional observational study with comprised of multi-ethnic groups, selected from amongst those attending our dental c. Fifty subjects reporting to the Department of Oral Medicine and Radiology with TMJ pathologies were selected. Radiological bone changes were evaluated for flattening (flat bony contour deviating from normal convex form) and erosion (area of decreased density of cortical bone and adjacent subcortical bone) by OPG. After that, MRI of TMJ been taken and changes in the disk position was recorded with the help of radiologist. Statistical Analysis: Statistical presentation and analysis of the present study were done using the p value and Chi-square test by SPSSV20. Results: Result obtained from our study showed that pain was present in 28 (56%) patients and only 44% patients having chief complain other than pain such as noise in front of ear while mastication or restricted mouth opening [Table 1] Out of 28 patients with a chief complain of pain, 22 patients (78.57%) were having abnormal/flattened condylar head surface but out of 22 patients with a chief complain other than pain 18 patients (81.82%) were having abnormal/flattened condylar head surface [Table 2]. Out of 28 patients with a chief complain of pain, 18 patients (64.28%) were with an shortened condylar neck and also out of 22 patients with a chief complain other than pain 16 patients (72.72%) were having shortened condylar neck. The result showed statistically non-significant (P > O.05) [Table 3]. Results also showed that 40% patients with Anterior Disc Displacement With Reduction (ADDR) and 50% with Anterior disc displacement without reduction (ADDWR) had abnormal condylar head surface [Table 4]. About 47.05% patients with ADDR and 41.17% with ADDWR had abnormal condylar neck [Table 5]. Even though there was a positive correlation between the OPG and MRI findings of the TMJ pathologies with the clinical findings of TMJ pathologies, result was not statistically significant which might be due to the reduced sample size. Conclusion: Based on the observation, it can be concluded that OPG and MRI provide valuable information regarding the temporomandibular disorders (TMD) and can play a key role in arriving at accurate clinical diagnosis of complex TMJ pathologies. It also makes the clinical diagnosis easy by correlating the clinical findings of the TMD with this imaging modality and helps clinician to arrive at the proper diagnosis and treatment plan at the earliest. This type of studies should be done on large scale in future based on specific parameters for early diagnosis and treatment planning for patients suffering with TMD to provide quality treatment to the patients at initial stage.