Association between pain, horizontal condylar angle, and degenerative changes
- 주제(키워드) Temporomandibular joint; Temporomandibular disorder; Degenerative joint disease; Horizontal condylar angle; Cone-beam computed tomography
- 발행기관 강릉원주대학교
- 지도교수 김영준
- 발행년도 2018
- 학위수여년월 2018. 2
- 학위명 박사
- 학과 및 전공 일반대학원 치의학과
- 원문페이지 42
- 본문언어 영어
- 저작권 강릉원주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Objective The aims of this study were to evaluate relationship between clinical and cone-beam computed tomographic findings and to evaluate alteration of pain, horizontal condylar angle (HCA), bone change type, and amount of erosion according to long-term change of degenerative joint disease (DJD) of the temporomandibular joint (TMJ). Materials and Methods In this study, cone-beam computed tomography (CBCT) images of TMJs and clinical records of 75 TMJ DJD patients, 13 temporomandibular disorder (TMD) patients, and 24 normal subjects were reviewed retrospectively. The TMJ condyles of 75 DJD patients were classified into five bone change types; N (normal), FS (Flattening/sclerosis), E (erosion), OE (osteophyte-erosion), and O (osteophyte) Differences of HCA according to bone type change and longitudinal change of erosion was investigated. HCA is an angle between the condylar long axis and the coronal line connecting both porion in the axial plane defined with both porion and the right infraorbitale. Correlation among demographic features (gender, age), clinical fingdings (numeric rating scale (NRS), craniomandibular index (CMI), pain duration), and radiographic fingdings (HCA, amount of erosion, bone change type) was analyzed. Long-term changes of pain, HCA, bone change type, and amount of erosion were reviewed. Pain was evaluated with NRS and CMI. Results Demographic features (gender, age), clinical findings (NRS, CMI, pain duration) and radiographic findings (HCA, amount of erosion) were correlated with each other. NRS and CMI were correlated with amount of erosion, and pain duration. HCA was inversely correlated with NRS, CMI, and age. There was a significant difference in HCA among 3 subject groups (normal, DJD, TMD), bone change types, groups according to amount of erosion. DJD-affected condyles had larger HCA than DJD-unaffected condyles. HCA increased gradually in early stage of DJD, and then it decreased in O type at later stable stage. Type E and FS , type O and OE showed similar bidirectional transition ratio as the follow-up period got longer. The decreasing tendency of amount of erosion persisted in 76.5% of condyles, while erosion increased again in 23.5% of condyles at second (2-3 years) follow-up Conclusions HCA, bone change type, and amount of erosion are correlated with each other and with clinical signs and symptoms. HCA increases as TMJ DJD proceeds and decreases again as condylar bone change gets stable. HCA can provide useful information during TMJ DJD diagnosis. Large HCA without bone changes can predict onset of DJD. Increase of HCA of DJD-affected condyle can predict early stage of DJD and decrease of HCA of DJD-affected condyle can predict regeneration. Because both HCA and bone change type change as TMJ DJD processes, checking them up together will be able to provide additional information to predict how TMJ DJD proceeds, destructively or regeneratively. Therefore, radiographic findings (ie. amount of erosion and bone change type, HCA) can be helpful in diagnosis and prognosis evaluation. Especially, the results show amount of erosion can be one of the biomarkers that can predict pain in TMJ DJD patients. The bidirectional change of TMJ DJD was noticed. Condylar bone change progresses even after the signs and symptoms of TMJ DJD alleviated or subsided. The structural sequela of DJD can be permanent (ie, malocclusion, face deformity). Therefore, radiographic follow-up for sufficient period (at least 3.5 years) is recommended.
more목차
I. Introduction 1
Ⅱ. Materials and Methods 2
1. CBCT data acquisition and classification of bone change
2. Measurement of horizontal condylar angle on CBCT images
3. Measurement of amount of erosion on CBCT images
4. Interobserver and intraobserver agreement
5. Statistical analysis
Ⅲ. Results ……..6
1. Cross-sectional correlation between clinical and radiographic findings
2. Longitudinal change of clinical and radiographic findings
1) Horizontal condylar angle
2) Bone remodeling
3) Erosion
Ⅳ. Discussion ……..11
Ⅴ. Conclusions ……..17
Ⅵ. Reference ……..18
Figures and tables ……..22
Abstract in Korean …42
