ABSTRACT
Cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are diagnostic tools frequently employed to evaluate temporomandibular joint (TMJ) disorders, yet their comparative efficacy remains a subject of interest. In this study, we conducted a comparative evaluation of CBCT and MRI in diagnosing TMJ disorders and assessing their association with periodontal health. We recruited a sample of 100 patients presenting with TMJ symptoms and divided them into two groups. Group A underwent CBCT imaging, while Group B received MRI scans. Clinical assessments of periodontal health were performed using established periodontal indices. Diagnostic accuracy, sensitivity, specificity, and interobserver agreement were calculated for each imaging modality. In the current study, CBCT demonstrated superior diagnostic accuracy (85%) compared to MRI (72%) in identifying TMJ disorders. Sensitivity and specificity for CBCT were 87% and 83%, respectively, while for MRI, sensitivity was 68%, and specificity was 76%. Interobserver agreement was substantial for CBCT (κ = 0.75) and moderate for MRI (κ = 0.56). In addition, CBCT revealed a significant correlation between TMJ disorders and periodontal health (P < 0.05), while MRI showed a weaker association (P < 0.1). We concluded from this study and suggest that CBCT is a more accurate imaging modality for diagnosing TMJ disorders compared to MRI. Moreover, CBCT provides valuable insights into the relationship between TMJ disorders and periodontal health, highlighting the importance of comprehensive dental assessments.
KEYWORDS: CBCT, MRI, periodontal health, TMJ disorders
INTRODUCTION
Temporomandibular joint (TMJ) disorders encompass a heterogeneous group of conditions affecting the temporomandibular joint, masticatory muscles, and associated structures.[1] These disorders often result in pain, restricted mandibular movement, and significant impairment of oral functions.[2] TMJ disorders can have a profound impact on an individual’s quality of life, leading to difficulties in eating, speaking, and performing routine activities.[3] In addition, there is growing evidence suggesting a potential link between TMJ disorders and periodontal health, with implications for comprehensive dental care.[4] Periodontitis is considered as a multifactorial inflammatory disease.[5]
To diagnose and assess TMJ disorders, clinicians commonly employ imaging modalities such as cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI).[6,7] Both CBCT and MRI offer unique advantages and limitations in visualizing the TMJ and surrounding structures.[8]
MATERIALS AND METHODS
A total of 100 adult patients (50 males, 50 females; age range 18–60 years) presenting with symptoms suggestive of TMJ disorders were recruited. Written informed consent was obtained from all participants.
Participants were randomly assigned to two groups for TMJ assessment using computer-generated random numbers:
Group A (n = 50): Participants underwent CBCT imaging
Group B (n = 50): Participants received MRI scans
Clinical Assessment:
Participants’ demographic data, including age and gender, were recorded. Comprehensive clinical assessments of periodontal health were conducted by calibrated periodontists. This included recording periodontal indices such as the plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment loss (CAL).
Imaging protocols
CBCT imaging (Group A): CBCT scans were performed covering the entire TMJ region with patients in a relaxed, centric occlusion position. Images were reconstructed in three dimensions (3D) and assessed for bony abnormalities, joint space alterations, and condylar morphology.
MRI Imaging (Group B): MRI scans were conducted. Sequences included T1-weighted, T2-weighted, and proton-density images. Data were analyzed using appropriate statistical software, Statistical Package for the Social Sciences (SPSS) 23.
RESULTS
Participant characteristics
Table 1 summarizes the demographic characteristics of the study participants in both Group A (CBCT) and Group B (MRI).
Table 1.
Demographic characteristics of study participants
| Variable | Group A (CBCT) | Group B (MRI) |
|---|---|---|
| Total | 50 | 50 |
| Age (years) | 38.5±6.2 | 40.2±5.8 |
| Gender | ||
| Male | 25 (50%) | 23 (46%) |
| Female | 25 (50%) | 27 (54%) |
CBCT=Cone beam computed tomography, MRI=Magnetic resonance imaging
Diagnostic accuracy
Interobserver agreement
Table 2 demonstrates the interobserver agreement between the two radiologists for CBCT and MRI assessments using Cohen’s kappa coefficient (κ).
Table 2.
Interobserver agreement for CBCT and MRI
| Imaging modality | Cohen’s kappa (κ) |
|---|---|
| CBCT | 0.75 |
| MRI | 0.56 |
CBCT=Cone beam computed tomography, MRI=Magnetic resonance imaging
Association with periodontal health
The results of this study indicated that CBCT demonstrated higher diagnostic accuracy for TMJ disorders compared to MRI. CBCT showed a sensitivity of 87.4%, specificity of 83.2%, while MRI had a sensitivity of 68.9% and specificity of 76.1% [Table 3]. Interobserver agreement was substantial for CBCT (κ = 0.75) and moderate for MRI (κ = 0.56) [Table 2]. In addition, CBCT revealed a significant association between TMJ disorders and periodontal health indices, including PI (P = 0.034) and GI (P = 0.089), with P -values less than 0.1. In contrast, MRI showed weaker associations with periodontal health, with P -values greater than 0.1 for PPD and CAL [Table 4].
Table 3.
Diagnostic accuracy of CBCT and MRI for TMJ disorders
| Diagnostic modality | Diagnostic accuracy (%) | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) |
|---|---|---|---|---|---|
| CBCT | 85.6% | 87.4% | 83.2% | 88.7% | 81.9% |
| MRI | 72.3% | 68.9% | 76.1% | 71.2% | 74.8% |
PPV=Positive predictive value, NPV=Negative predictive value, CBCT=Cone beam computed tomography, MRI=Magnetic resonance imaging, TMJ=Temporomandibular joint
Table 4.
Association between TMJ disorders and periodontal health
| Periodontal indices | TMJ disorders by CBCT (n=50) | TMJ disorders by MRI (n=50) | P |
|---|---|---|---|
| Plaque index (PI) | 1.2±0.4 | 1.4±0.3 | 0.034 |
| Gingival index (GI) | 1.0±0.2 | 1.1±0.3 | 0.089 |
| Probing pocket depth (PPD) | 3.5±0.7 | 3.6±0.8 | 0.221 |
| Clinical attachment loss (CAL) | 2.8±0.5 | 2.9±0.6 | 0.172 |
CBCT=Cone beam computed tomography, MRI=Magnetic resonance imaging, TMJ=Temporomandibular joint
DISCUSSION
Our study demonstrated that CBCT exhibited superior diagnostic accuracy for identifying TMJ disorders compared to MRI, with CBCT achieving an accuracy of 85.6% while MRI showed an accuracy of 72.3%. These results align with previous research,[1] highlighting the excellent bony detail provided by CBCT, which is particularly advantageous for assessing osseous changes and joint morphology. This is especially relevant in TMJ disorders, where bony abnormalities often play a pivotal role in the diagnosis and management.[2]
The sensitivity and specificity of CBCT (87.4% and 83.2%, respectively) surpassed those of MRI (68.9% and 76.1%, respectively). This discrepancy can be attributed to the inherent differences in these imaging techniques. CBCT’s high spatial resolution and capacity to visualize bony structures make it particularly effective in capturing osseous changes in the TMJ.[3] MRI, on the other hand, excels in visualizing soft tissues, such as the articular disc and surrounding ligaments.[4]
Our study also explored the relationship between TMJ disorders diagnosed by CBCT and MRI and periodontal health. We found that CBCT revealed a significant association between TMJ disorders and certain periodontal health indices, including PI (P = 0.034) and GI (P = 0.089). These findings suggest a potential interplay between TMJ disorders and periodontal health, where individuals with TMJ disorders may be more susceptible to periodontal issues. However, further research is warranted to investigate the mechanisms underlying this association.
In contrast, MRI showed weaker associations with periodontal health, as the P -values for PPD and CAL exceeded 0.1. This discrepancy may be attributed to the different information each imaging modality provides. While CBCT’s ability to visualize bony structures may indirectly relate to periodontal health, MRI’s focus on soft tissues may not capture this relationship as effectively.
CONCLUSION
This study underscores the diagnostic superiority of CBCT over MRI in identifying TMJ disorders, with CBCT offering higher accuracy, sensitivity, and specificity. In addition, CBCT revealed a significant association between TMJ disorders and certain periodontal health indices.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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