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Magnetic resonance imaging in patients with temporomandibular disorders and pain
Malmö högskola, Faculty of Odontology (OD).
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Magnetic resonance imaging (MRI) is the method of choice for imaging disorders of the temporomandibular joint (TMJ) in patients with temporomandibular disorders (TMD) and pain. But the method is expensive, and wait times for MRI exams of the TMJ are long. So an evaluation of the diagnostic and therapeutic efficacy of MRI of the TMJ is valuable when estimating the imaging method’s use in treatment decisions and prognosis. To reduce cost to society, individual selection criteria for MRI of the TMJ need to be defined. The aim must be to minimize unnecessary examinations and to restrict use of MRI to patients who will benefit from the examination. To evaluate evidence for the efficacy of MRI in patients with TMD and pain, a systematic review of the literature was done (article I). The search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence; 12 and 10 publications had moderate and low levels of evidence, respectively. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient. No publication on diagnostic thinking efficacy or therapeutic efficacy met the inclusion criteria. The TMJs of 60 TMD patients were examined with MRI (article II). The patients were placed in one of two clinical diagnostic groups—(1) myofascial pain or (2) arthralgia/osteoarthritis—per the Research Diagnostic Criteria for TMD (RDC/TMD), a diagnostic classification system. This classification is widely used internationally, but further validation and development is needed. The most common MRI findings were various kinds of disc displacements; structural bone changes; and joint fluid, which occurred in both pain groups. The MRI findings did not support the RDC/TMD clinical diagnoses. In a randomized controlled trial of 80 patients suffering from TMD pain (article III), the short-term efficacy of a resilient appliance was compared with a control appliance consisting of a non-occlusal hard acrylic palatal appliance. After 10 weeks of treatment, 61% in the treatment group and 46% in the control group had at least a 30% reduction in TMD pain. Differences between groups were nonsignificant. Changes in condyle and disc position could be factors that are affected by appliance therapy and influence treatment outcome of TMD patients. MRI of the TMJ was performed in 48 of the 80 patients (article IV). The results showed that treatment outcome was not related to MRI-determined changes in condyle and disc position.

Place, publisher, year, edition, pages
Malmö University , 2008. , p. 127
Series
Doctoral Dissertation in Odontology
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-7670Local ID: 7355ISBN: 9171042997 (print)OAI: oai:DiVA.org:mau-7670DiVA, id: diva2:1404610
Note

Paper III and IV in dissertation as manuscripts.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-19Bibliographically approved
List of papers
1. The efficacy of magnetic resonance imaging in the diagnosis of degenerative and inflammatory temporomandibular joint disorders: a systematic literature review
Open this publication in new window or tab >>The efficacy of magnetic resonance imaging in the diagnosis of degenerative and inflammatory temporomandibular joint disorders: a systematic literature review
2006 (English)In: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, ISSN 1079-2104, E-ISSN 1528-395X, Vol. 102, no 4, p. 521-536Article, review/survey (Other academic) Published
Abstract [en]

Objective. To evaluate the evidence for the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disk position and configuration, disk perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint. Study design. A PubMed literature search with specific indexing terms and a hand search were made. Two reviewers assessed the level of evidence of relevant publications as high, moderate, or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited, or insufficient. Results. The literature search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence, and 12 had moderate and 10 low levels of evidence. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient. Conclusion. That evidence is insufficient emphasizes the need for high-quality studies on the diagnostic efficacy of MRI, incorporating accepted methodologic criteria.

Keywords
magnetic resonance imaging, systematic review, temporomandibular disorders, temporomandibular joint
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-1041 (URN)10.1016/j.tripleo.2006.02.001 (DOI)16997121 (PubMedID)2-s2.0-33748885775 (Scopus ID)3637 (Local ID)3637 (Archive number)3637 (OAI)
Available from: 2020-02-27 Created: 2020-02-27 Last updated: 2024-02-06Bibliographically approved
2. Clinical diagnoses and MRI findings in patients with TMD pain
Open this publication in new window or tab >>Clinical diagnoses and MRI findings in patients with TMD pain
Show others...
2007 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 34, no 4, p. 237-245Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to correlate clinical diagnoses in temporomandibular disorders patients suffering from pain diagnosed as arthralgia/osteoarthritis or myofascial pain according to the Research Diagnostic Criteria for temporomandibular disorders with findings made on magnetic resonance imaging. The temporomandibular joints of 60 consecutive patients, 41 with arthralgia/osteoarthritis and 19 with myofascial pain, were examined clinically and with magnetic resonance imaging. The most common magnetic resonance imaging findings were disc displacements and structural bone changes, which were found in both pain groups. However, disc displacements were found significantly (p = 0.002) more often in the arthralgia/osteoarthritis group. 104 joints were found to have no clinical diagnosis of disc displacements, but 64 of these joints had findings of disc displacements on magnetic resonance imaging. Joint fluid was found both in the arthralgia/osteoarthritis group (20 patients) and in the myofascial pain group (5 patients). Patients having a combination of disc displacement and joint fluid were significantly (p = 0.047) more common in the arthralgia/osteoarthritis group. In conclusion, the magnetic resonance imaging findings of disc displacement and structural bone changes were common in temporomandibular disorders patients with pain of both myogenous and arthrogenous origin. The clinical diagnoses for subdivision into myogenous and arthrogenous pain groups were not confirmed by magnetic resonance imaging.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2007
Keywords
arthralgia, magnetic resonance imaging, myofascial pain, osteoarthritis, temporomandibular disorders, temporomandibular joint
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15428 (URN)10.1111/j.1365-2842.2006.01719.x (DOI)000245628100001 ()17371560 (PubMedID)2-s2.0-33947309073 (Scopus ID)4621 (Local ID)4621 (Archive number)4621 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
3. Short-term treatment of a resilient appliance in TMD pain patients: a randomized controlled trial
Open this publication in new window or tab >>Short-term treatment of a resilient appliance in TMD pain patients: a randomized controlled trial
2009 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 36, no 8, p. 547-555Article in journal (Refereed) Published
Abstract [en]

To investigate the short-term efficacy of a resilient appliance in patients with temporomandibular disorders (TMD) suffering from pain, a randomized, controlled trial was performed in 80 recruited TMD pain patients. They were randomly allocated to one of two groups: treatment with a resilient appliance or treatment with a hard, palatal, non-occluding appliance. The primary treatment outcome measure was judged positive when patients' TMD pain at worst, according to the Visual Analog Scale (VAS), decreased by at least 30%. One additional treatment outcome was reduction of characteristic pain intensity. Number needed to treat was measured on the basis of primary treatment outcome at 10 weeks. At baseline, patient characteristics and TMD pain did not differ between the groups. There were no significant differences between groups regarding a 30% reduction in VAS-reported TMD pain at worst at 10 weeks' follow-up; 61% in the treatment group and 46% in the control group. After 6 and 10 weeks of treatment, CPI decreased in both groups. Number needed to treat was 9.1 for both the resilient and the control appliance therapy during 10 weeks. There was no statistically significant difference between the resilient appliance and the non-occluding control appliance in reducing TMD pain from a short-term perspective.

Place, publisher, year, edition, pages
Blackwell Publishing, 2009
Keywords
resilient appliance, temporomandibular disorders, occlusal appliance, orofacial pain, randomized controlled trial
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6862 (URN)10.1111/j.1365-2842.2009.01973.x (DOI)000267754500001 ()19604318 (PubMedID)2-s2.0-67650912267 (Scopus ID)9906 (Local ID)9906 (Archive number)9906 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
4. Resilient appliance-therapy treatment outcome in patients with TMD pain correlated to MRI-determined changes in condyle position
Open this publication in new window or tab >>Resilient appliance-therapy treatment outcome in patients with TMD pain correlated to MRI-determined changes in condyle position
2009 (English)In: Cranio, ISSN 0886-9634, E-ISSN 2151-0903, Vol. 27, p. 185-193Article in journal (Refereed) Published
Abstract [en]

The aim of this research was to study if changes in condyle position in temporomandibular disorders (TMD) patients could be a factor that is affected by resilient appliance therapy and if it influences the treatment outcome. The study investigated 48 patients randomly assigned to a treatment group (T group = 21 patients, using resilient appliance) or a control group (C group = 27 patients, using nonoccluding appliance). Changes in the condyle-fossa relationship (with and without the appliance) were determined in an MRI examination. Ten weeks after treatment, the treatment outcome was measured. The results showed that with the appliance, change in condyle position occurred in 76% of the T group and 22% of the C group (p < 0.001). Sixty-seven percent (67%) of the T group and 44% of the C group experienced a successful treatment outcome. Treatment outcome was not related to changes in condyle position in patients with TMD pain.

Place, publisher, year, edition, pages
CHROMA, Inc, 2009
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6648 (URN)10.1179/crn.2009.028 (DOI)000208022500008 ()19697647 (PubMedID)2-s2.0-74849104109 (Scopus ID)9120 (Local ID)9120 (Archive number)9120 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-05-06Bibliographically approved

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