Abstract
Objectives:
The aim was to evaluate the morphology of the temporomandibular joint's (TMJs) disc and condyle as well as its correlation with disc displacement, using MRI.
Methods:
190 TMJs were retrospectively analysed. The condyle morphology of each TMJ was evaluated by two observers using both axial and coronal views, as were their disc morphology and displacement, using sagittal view. Condyle morphology was classified as flat, convex, angled or rounded in the coronal sections and as anterior side flat/posterior side convex, biconvex, anterior side concave/posterior side convex, flat or biconcave in the axial view. Disc morphology was determined as biconcave, biplanar, biconvex, hemiconvex or folded. χ2, Fisher exact and Bonferroni correction tests were used to evaluate the data. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between age and disc displacement.
Results:
Anterior disc displacement with reduction; convex condyle morphology in the coronal view; anterior side concave/posterior side convex morphology in the axial view; and biconcave discs were found to be the most prevalent findings. An association was observed between disc morphology and disc displacement (p < 0.001). No correlation between condyle morphology and TMJ disc displacement was found (p = 0.291 for axial and p = 0.14 for coronal views).
Conclusions:
The results of this study suggest that TMJ disc morphology is associated with disc displacement.
Keywords: temporomandibular joint disorders, magnetic resonance imaging, temporomandibular joint disc
Introduction
The temporomandibular joint (TMJ) is the articulation between the condyle head and the squamous portion of the temporal bone in the skull base. Interposed between the bone surfaces is the articular disc,1–5 a fibrocartilaginous plate that is typically described as having a biconcave morphology. It is divided into three parts: the anterior band, posterior band and intermediate zone.1,3 In a healthy joint, the disc is perfectly placed between the articular surfaces throughout the mandibular movement.1,6 When the disc is normally positioned, the intermediate zone lies interposed between the condyle and the articular eminence, and the posterior band above the head of the mandible.7
Despite the TMJ disc's clinical relevance, little is known about its aetiopathogenesis.8 It is necessary to understand the natural course of disc displacement to develop an effective therapy for this disorder.9 As there is an intimate relationship between form and function, many authors have suggested that the TMJ's morphology is related to functional changes that result in the displacement of the articular disc.10 Therefore, several authors have evaluated the morphologies of the condyle and articular disc and investigated the correlation between their morphology and disc displacement.2,7,9–17
MRI is considered the gold standard imaging modality for evaluating TMJ discs, as it produces images of excellent soft-tissue contrast.10,18–20 Moreover, it is a non-invasive examination that is free of ionizing radiation.16,20,21
Therefore, the aim of this study was to evaluate the morphology of the articular disc and condyle in the coronal and axial views and to correlate these findings with the position of the articular disc, using MRI.
Methods and materials
This retrospective cross-sectional study protocol was approved by the institutional review board of the State University of Paraíba, Brazil, and is in compliance with the Helsinki Declaration. All subjects provided written informed consent.
The study was conducted on all of the MRIs performed between 2009 and 2012 in a private practice. To be included in the study, the subject had to present at least one of the following signs and symptoms: pain in joints and/or muscles, joint sounds, limitation of movement, history of headaches and otologic complaints. The following exclusion criteria were used: patients with previous surgeries in their TMJ; systemic, inflammatory joint disease; facial growth disorders; history of direct trauma or facial bone fracture; hypoplasia, hyperplasia or tumours of the TMJ; and syndromes. After applying the exclusion criteria, the sample was composed of 114 subjects. However, another 19 examinations were excluded from the sample: 10 for poor image quality and 9 for lack of some data in the patient file. The final sample was therefore 95 subjects (15 males and 80 females), aged 16–81 years (mean age, 39 years), totalling 190 joints.
Prior to the MRI scan, an oral and maxillofacial radiologist (PSFC) with special training in TMJ evaluation and 15 years' experience performed a clinical examination on all of the subjects. Sex and the presence of joint pain, as reported by the subject, were registered accordingly.
The MRI studies were performed using a 1.5-T GE Signa® scanner (General Electric, Milwaukee, WI) and a bilateral TMJ dual-phased array coil (Signa; General Electric Medical Systems). The subjects were positioned in the supine position, with the sagittal plane perpendicular to the horizontal plane and the Frankfort plane parallel to the scanner gantry. The protocol consisted of a 256 × 256 pixel matrix, 145-mm field of view and a pixel size of 0.60 × 0.57 mm. Based on an axial localizer [repetition time (TR), 400 ms; echo time (TE), 13 ms; number of excitations (NEX), one; scan time, 58 s; slice thickness, 4 mm], oblique parasagittal slices were obtained and corrected by the horizontal angulation of the condyle, in both open- and closed-mouth positions. 10 slices, 2-mm thick, were obtained for each TMJ using spin echo T1 weighted (TR, 400 ms; TE, 26 ms; NEX, four; scan time, 3 min 44 s) and spin echo T2 weighted (TR, 3200 ms; TE, 85 ms; NEX, four; scan time, 5 min 12 s) sequences. For the acquisition of images in the open-mouth position, a Burnett TMJ device (TMJ-200s/n 0650; Medrad Inc., Pittsburgh, PA) was used to stabilize the maximal opened-mouth position and minimize motion artefacts. Sequential sagittal images for the open- and closed-mouth positions, as well as coronal and axial images for the closed-mouth position, were obtained. During the MRI examination, if one of the radiologists thought that proton density was needed to evaluate a specific case, then such images were also acquired (proton density fast spin echo: TR, 1584 ms; TE, 24 ms; NEX, three; scan time, 3 min 28 s).
The position of the disc in closed-mouth images was evaluated and classified as normal (N) or displaced, using the classification of Tasaki et al.22 In our study, cases of partial anterior disc displacement in the lateral part of the joint, partial anterior disc displacement in the medial part of the joint, rotational anterolateral disc displacement and rotational anteromedial disc displacement were grouped together with the ones of anterior disc displacement for purposes of statistical analysis. For this reason, discs were categorized into the following groups: normal position (N); anterior displacement with reduction; anterior displacement without reduction (ADWOR); posterior displacement; and medial or lateral displacement.
Axial and coronal sequences were used to assess the condyle morphology. The slices in which the largest latero-lateral size of the condyle was observed were chosen for the morphology analysis. The classification used was the one suggested by Yale et al,23 modified by Alomar et al1 (Figures 1 and 2). In both the coronal and axial views, the “other” category was added for those condyles that did not correspond to any of the proposed categories.
Figure 1.
Classification of condyle morphology in the coronal view: (a) flat, (b) convex, (c) angled and (d) round.
Figure 2.
Classification of condyle morphology in the axial view: (a) flat/convex, (b) biconvex, (c) concave/convex, (d) flat and (e) biconcave.
Using Microsoft® PowerPoint® Office 2013 (Microsoft, Redmond, WA) and Adobe® Photoshop® Elements (Adobe Systems, San Francisco, CA) software, the outline of all of the morphological categories that were pre-established for condyle MRI evaluation was designed and printed, for superimposition onto images when the observer was unsure of which category the condyle would fit in, thus assisting the diagnosis.
The image sequences in the sagittal closed-mouth position were used to evaluate the disc's morphology, and the chosen slices were those in which the disc was represented at its largest. Murakami et al24 classification was used for this evaluation, as follows: biconcave, both upper and lower surfaces are concave; biplanar, even thickness; biconvex, both upper and lower surfaces are convex; hemiconvex, upper surface is concave and lower is convex; and folded, the disc is folded at the centre (Figure 3).
Figure 3.
Classification of disc morphology: (a) biconcave, (b) biplanar, (c) biconvex, (d) hemiconvex and (e) folded.
Two experienced radiologists evaluated all of the MRI images in a consensus approach, without consulting any clinical information. The data analysis was performed using R software v. 3.15.127 (R Foundation for Statistical Computing, Vienna, Austria). χ2 test, Fisher exact test and χ2 partition were used when necessary and in addition to the descriptive statistics of central tendency (mean), dispersion (standard deviation) and absolute and relative frequencies. In the event of p-values ≤0.05, Bonferroni correction was applied to compare the proportions between the columns of the contingency tables. For the intersection between age and disc position, one-way ANOVA followed by a post hoc Tukey's test were used.
Results
190 TMJs were analysed. The frequencies of the observed disc positions and morphologies, as well as the condyle morphologies in the coronal and axial views, are listed in Table 1.
Table 1.
Absolute and relative frequencies for each studied variable
| Variable | F (%) |
|---|---|
| Disc position | |
| Anterior disc displacement with reduction | 56 (29.5) |
| Anterior disc displacement without reduction | 37 (19.5) |
| Medial or laterial displacement | 20 (10.5) |
| Posterior displacement | 2 (1.1) |
| Normal position | 75 (39.5) |
| Condyle morphology in axial section | |
| Anterior side flat/posterior side convex | 52 (27.4) |
| Biconvex | 32 (16.8) |
| Anterior side concave/posterior side convex | 73 (38.4) |
| Flat | 21 (11.1) |
| Biconcave | 8 (4.2) |
| Others | 4 (2.1) |
| Condyle morphology in coronal section | |
| Flat | 46 (24.2) |
| Convex | 66 (34.7) |
| Angled | 55 (28.9) |
| Round | 18 (9.5) |
| Others | 5 (2.6) |
| Disc morphology | |
| Biconcave | 142 (74.7) |
| Biconvex | 7 (3.7) |
| Biplanar | 5 (2.6) |
| Folded | 19 (10) |
| Hemiconvex | 15 (7.9) |
| Others | 2 (1.1) |
F, absolute frequency.
There was no statistical correlation between disc displacement and condyle morphology in both the axial and coronal views (p = 0.29 and 0.14, respectively) (Table 2). There was a statistically significant association between the disc position and disc morphology variables (p < 0.001). The post hoc test revealed that the co-occurrence of ADWOR and a biconcave disc was significantly less frequent than with the other disc positions. Furthermore, the intersection between displacement without reduction and a folded disc appeared with higher frequency than the crossover between normally positioned discs and folded discs (Table 2).
Table 2.
Association between disc position and the independent variables [n (%)]
| Variable | Disc position |
Total | p-value | ||||
|---|---|---|---|---|---|---|---|
| Anterior disc displacement with reduction | Anterior disc displacement without reduction | Medial or laterial displacement | Posterior displacement | Normal position | |||
| Condyle morphology in axial section | |||||||
| Anterior side flat/posterior side covex | 20 (36.4%) | 8 (23.5%) | 1 (5.3%) | – | 23 (30.7%) | 52 (28.1%) | 0.291a |
| Biconvex | 9 (16.4%) | 3 (8.8%) | 5 (26.3%) | 2 (100%) | 13 (17.3%) | 32 (17.3%) | |
| Anterior side concave/posterior side convex | 21 (38.2%) | 17 (50%) | 8 (42.2%) | – | 26 (34.7%) | 73 (38.9%) | |
| Flat | 3 (5.5%) | 4 (11.8%) | 3 (15.8%) | – | 11 (14.7%) | 21 (11.4%) | |
| Biconcave | 2 (3.6%) | 2 (5.9%) | 2 (10.5%) | – | 2 (2.7%) | 8 (4.3%) | |
| Condyle morphology in coronal section | |||||||
| Flat | 12 (22.2%) | 8 (22.2%) | 2 (10%) | – | 24 (32%) | 46 (24.6%) | 0.14a |
| Convex | 22 (40.7%) | 11 (30.6%) | 9 (45%) | – | 24 (32%) | 66 (35.3%) | |
| Angled | 17 (31.5%) | 11 (30.6%) | 4 (20%) | 1 (50%) | 22 (29.3%) | 55 (29.4%) | |
| Round | 3 (5.6%) | 6 (16.7%) | 5 (25%) | 1 (50%) | 5 (6.7%) | 20 (10.7%) | |
| Disc morphology | |||||||
| Biconcave | 47A (85.5%) | 10B (27.8%) | 17A (85%) | – | 68A (90.7%) | 142 (75.5%) | <0.001a |
| Biconvex | – | 3A,B (8.3%) | 2B (10%) | 2 (100%) | – | 7 (3.7%) | |
| Biplanar | 1A (1.8%) | 2A (5.6%) | – | – | 2A (2.7%) | 5 (2.7%) | |
| Folded | – | 18B (20%) | – | – | 1A (1.3%) | 19 (10.1%) | |
| Hemiconvex | 7A (12.7%) | 3A (8.3%) | 1A (5%) | – | 4A (5.3%) | 15 (8%) | |
| Total | 55 (100%) | 36 (100%) | 20 (100%) | 2 (100%) | 75 (100%) | 188 (100%) | |
Fisher's exact test. Different uppercase letters in table data indicate statistical differences.
Sex had a significant correlation with the position of the disc: 66.7% of the male subjects were classified with normally positioned discs against 34.4% of the female subjects (Table 3).
Table 3.
Association between gender and the other variables [n (%)]
| Variable | Male | Female | Total | p-value |
|---|---|---|---|---|
| Disc position | ||||
| Anterior disc displacement with reduction | 6A (20%) | 50A (31.3%) | 56 (29.5%) | <0.01a |
| Anterior disc displacement without reduction | 2A (6.7%) | 35A (21.9%) | 37 (19.5%) | |
| Medial or laterial displacement | 2A (6.7%) | 18A (11.3%) | 20 (10.5%) | |
| Posterior displacement | – | 2 (1.3%) | 2 (1.1%) | |
| Normal position | 20A (66.7%) | 55B (34.4%) | 75 (39.5%) | |
| Condyle morphology in axial section | ||||
| Anterior side flat/posterior side covex | 6 (20.7%) | 46 (29.5%) | 52 (28.1%) | 0.49a |
| Biconvex | 5 (17.2%) | 27 (17.3%) | 32 (17.3%) | |
| Anterior side concave/posterior side convex | 11 (37.9%) | 61 (39.1%) | 72 (38.9%) | |
| Flat | 6 (20.7%) | 15 (9.6%) | 21 (11.4%) | |
| Biconcave | 1 (3.4%) | 7 (4.5%) | 8 (4.3%) | |
| Condyle morphology in coronal section | ||||
| Flat | 10 (35.7%) | 36 (22.6%) | 46 (24.6%) | 0.48a |
| Convex | 8 (28.6%) | 58 (36.5%) | 66 (35.3%) | |
| Angled | 8 (28.6%) | 47 (29.6%) | 55 (29.4%) | |
| Round | 2 (7.1%) | 18 (11.3%) | 20 (10.7%) | |
| Disc morphology | ||||
| Biconcave | 27 (90%) | 115 (72.8%) | 142 (75.5%) | 0.32a |
| Biconvex | – | 7 (4.4%) | 7 (3.7%) | |
| Biplanar | – | 5 (3.2%) | 5 (2.7%) | |
| Folded | 2 (6.7%) | 17 (10.8%) | 19 (10.1%) | |
| Hemiconvex | 1 (3.3%) | 14 (8.9%) | 15 (8%) | |
Fisher's exact test. Different uppercase letters in table data indicate statistical differences.
When intersecting the variables with age, some of the groups differed from each other. The ADWOR had a higher average age than that found in normally positioned discs (Table 4).
Table 4.
Age distribution among the disc position groups (years)
| Disc position | Mean value | Range | Confidence interval (95%) |
Minimum | Maximum | |
|---|---|---|---|---|---|---|
| Inferior | Superior | |||||
| Anterior disc displacement with reduction | 41.21A,C | 14.64 | 37.29 | 45.14 | 22 | 81 |
| Anterior disc displacement without reduction | 43.62A | 18.02 | 37.61 | 49.63 | 22 | 76 |
| Medial or laterial displacement | 33.40B,C | 10.74 | 28.37 | 38.43 | 16 | 60 |
| Posterior displacement | 41.00 | 0 | 41.00 | 41.00 | 41 | 41 |
| Normal position | 37.33C | 12.29 | 34.50 | 40.16 | 16 | 81 |
| Total | 39.33 | 14.32 | 37.28 | 41.38 | 16 | 81 |
ANOVA post hoc Tukey's test. Different uppercase letters in table indicate statistical differences (p < 0.05).
Discussion
The predominance of female subjects, as observed in this study, was already reported in a series of studies on TMJ dysfunction.7,21,22,25 Although there is no consensus on why this occurs, some theories have been proposed. The first states that this difference is related to an increased demand for treatment from females and not to their greater predisposition towards TMJ degenerative diseases.26 Another suggests that the difference is owing to a change in collagen metabolism associated with joint laxity of genetic origin.27 Some studies also suggest that oestradiol—the female sexual hormone—induces pro-inflammatory cytokines, aggravating TMJ inflammation.28
There was a significant association between sex and the position of the articular disc, with female subjects presenting a smaller number of discs in the normal position. This difference, however, can be owing to the small number of male subjects in the study's sample.
Most of the discs were in the normal position, and the most frequent type of displacement was anterior displacement with reduction, occurring in 29.5% of the cases. The rarest type of displacement was the posterior displacement, found in only 1.1% of the cases. The rarity of the posterior displacement was reported earlier.29 However, there is no consensus among authors when it comes to anterior disc displacement. Some point out that anterior displacement with reduction is the most frequent type of disc displacement, as found in our study,7,15,21,30 whereas others observed higher prevalence of ADWOR.9,30,31 These differences must be related to the sample's characteristics (age and symptoms, for example), since disc displacement is a chronic disease.31
The most prevalent morphology of the condyle in the axial view was anterior side concave/posterior side convex (37.9%), while the most unusual was biconcave (4.2%). These findings diverge from those of Yale et al23 and Sülün et al,16 who observed a higher prevalence of condyles with a convex anterior surface (biconvex). No association was observed between axial morphology and the position of the disc, in agreement with Raustia and Pyhtinen32 and Solberg et al.33 Sülün et al16 found an association between these variables, probably because they used a different sample (composed exclusively by symptomatic subjects) and a classification with a fewer number of categories, thus increasing the possibilities of statistical association.
Regarding the condyle morphology in the coronal section, our findings are in agreement with Yale et al,23 who also found the convex type to be the most prevalent and the rounded type the most unusual. Cholitgul et al21 observed a greater number of rounded condyles; however, they used a classification with only three categories: round, flat and concave. Thus, condyles that would be classified as convex in our study may have been included in the rounded type, explaining the different results. Matsumoto et al34 also used only three classifications: convex, angled and flat, with the convex type being the most prevalent in patients with both affected and unaffected sides, in accordance with our findings.
Our findings also diverge from Santos et al,15 who observed a higher prevalence of flattened condyles. These authors claim that condyle morphology is associated with the stage of disc displacement. Therefore, differences in the sample's composition could explain the dissonance in the results, given that there were a considerably lower number of patients with disc displacement without reduction in our sample, when compared with theirs.
It has been hypothesized that form and function are closely linked; thus, in the presence of condylar morphology changes, disc position should also change.11 Although expected, the association between condyle morphology and TMJ disc displacement was not observed in the present study. A different theory may explain our results, as other factors may affect condyle morphology (e.g. excessive occlusal force), condyle morphology may be interpreted as a normal variation and not a pathology itself, and may not be related to disc position.34 Disc displacement, as in the mediolateral position, may also have a further association with jaw function movement, rather than the morphology of the TMJ's components.34
Nonetheless, some studies found a higher prevalence of anterior disc displacement in convex and rounded condyles,15 and angled condyles.16 Another study applied a more accurate method, in which condyle dimensions were defined by measures and found an association between narrower condyles in the anteroposterior and transverse directions with disc displacement.35 Discrepancies in the results may be associated with different methodologies of evaluating condylar morphology.
Biconcavity is considered to be the normal form of TMJ disc. Changes in disc morphology are a characteristic factor of internal TMJ derangement.1,3 The prevalence of discs with normal morphology in our sample may indicate that this is a sample in the early stages of internal derangement. The results showed an association between disc displacement and changes in the morphology of the articular disc, in agreement with the literature.7,15,24,36–38 Most of the normally positioned discs showed a biconcave shape, while none of them had a folded shape. Additionally, all of the folded discs were found in patients in advanced stages of internal derangement (ADWOR). Similar results were found by Murakami et al24 and Hirata et al.10 These findings indicate that the articular disc tends to become deformed with the advancement of disc displacement. We cannot, however, assert a relationship of cause and effect because of this study's design; a longitudinal study would be more appropriate for that.
Conclusion
In conclusion, no correlation was found between the morphology of the condyle and TMJ disc displacement. However, an association between the shape of the articular disc and disc displacement was observed.
Contributor Information
S L S Melo, Email: sauloleonardo-sousamelo@uiowa.edu.
D P de Melo, Email: danipita@gmail.com.
References
- 1.Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al. Anatomy of the temporomandibular joint. Semin Ultrasound CT MR 2007; 28: 170–83. doi: 10.1053/j.sult.2007.02.002 [DOI] [PubMed] [Google Scholar]
- 2.Hegde S, Praveen BN, Shetty SR. Morphological and radiological variations of mandibular condyles in health and diseases: a systematic review. Dentistry 2013; 3: 154. [Google Scholar]
- 3.Molinari F, Manicone PF, Raffaelli L, Raffaelli R, Pirronti T, Bonomo L. Temporomandibular joint soft-tissue pathology, I: disc abnormalities. Semin Ultrasound CT MR 2007; 28: 192–204. doi: 10.1053/j.sult.2007.02.004 [DOI] [PubMed] [Google Scholar]
- 4.Okeson JP. Joint intracapsular disorders: diagnostic and nonsurgical management considerations. Dent Clin North Am 2007; 51: 85–103. doi: 10.1016/j.cden.2006.09.009 [DOI] [PubMed] [Google Scholar]
- 5.Tomas X, Pomes J, Berenguer J, Quinto L, Nicolau C, Mercader JM, et al. MR imaging of temporomandibular joint dysfunction: a pictorial review. Radiographics 2006; 26: 765–81. doi: 10.1148/rg.263055091 [DOI] [PubMed] [Google Scholar]
- 6.Vasconcelos Filho JO, Menezes AV, Freitas DQ, Manzi FR, Bóscolo FN, de Almeida SM. Condylar and disk position and signs and symptoms of temporomandibular disorders in stress-free subjects. J Am Dent Assoc 2007; 138: 1251–5. doi: 10.14219/jada.archive.2007.0351 [DOI] [PubMed] [Google Scholar]
- 7.Milano V, Desiate A, Bellino R, Garofalo T. Magnetic resonance imaging of temporomandibular disorders: classification, prevalence and interpretation of disc displacement and deformation. Dentomaxillofac Radiol 2000; 29: 352–61. doi: 10.1038/sj.dmfr.4600555 [DOI] [PubMed] [Google Scholar]
- 8.Manfredini D. Etiopathogenesis of disk displacement of the temporomandibular joint: a review of the mechanisms. Indian J Dent Res 2009; 20: 212–21. doi: 10.4103/0970-9290.51365 [DOI] [PubMed] [Google Scholar]
- 9.Cai XY, Jin JM, Yang C. Changes in disc position, disc length, and condylar height in the temporomandibular joint with anterior disc displacement: a longitudinal retrospective magnetic resonance imaging study. J Oral Maxillofac Surg 2011; 69: e340–6. doi: 10.1016/j.joms.2011.02.038 [DOI] [PubMed] [Google Scholar]
- 10.Hirata FH, Guimarães AS, Oliveira JX, Moreira CR, Ferreira ET, Cavalcanti MG. Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI. Braz Oral Res 2007; 21: 265–71. doi: 10.1590/s1806-83242007000300013 [DOI] [PubMed] [Google Scholar]
- 11.Hasegawa H, Saitoh I, Nakakura-Ohshima K, Shigeta K, Yoshihara T, Suenaga S, et al. Condylar shape in relation to anterior disk displacement in juvenile females. Cranio 2011; 29: 100–10. doi: 10.1179/crn.2011.018 [DOI] [PubMed] [Google Scholar]
- 12.Major PW, Kinniburgh RD, Nebbe B, Prasad NG, Glover KE. Tomographic assessment of temporomandibular joint osseous articular surface contour and spatial relationships associated with disc displacement and disc length. Am J Orthod Dentofacial Orthop 2002; 121: 152–61. doi: 10.1067/mod.2002.120641 [DOI] [PubMed] [Google Scholar]
- 13.Ohnuki T, Fukuda M, Nakata A, Nagai H, Takahashi T, Sasano T, et al. Evaluation of position, mobility and morphology of the disc by MRI before and after four different treatments for temporomandibular joint disorders. Dentomaxillofac Radiol 2006; 35: 103–9. [DOI] [PubMed] [Google Scholar]
- 14.Orhan K, Nishiyama H, Tadashi S, Murakami S, Furukawa S. Comparison of altered signal intensity, position, and morphology of the TMJ disc in MR images corrected for variations in surface coil sensitivity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 515–22. doi: 10.1016/j.tripleo.2005.04.004 [DOI] [PubMed] [Google Scholar]
- 15.Santos KC, Dutra ME, Warmling LV, Oliveira JX. Correlation among the changes observed in temporomandibular joint internal derangements assessed by magnetic resonance in symptomatic patients. J Oral Maxillofac Surg 2013; 71: 1504–12. doi: 10.1016/j.joms.2013.04.033 [DOI] [PubMed] [Google Scholar]
- 16.Sülün T, Akkayan B, Duc JM, Rammelsberg P, Tuncer N, Gernet W. Axial condyle morphology and horizontal condylar angle in patients with internal derangement compared to asymptomatic volunteers. Cranio 2001; 19: 237–45. [DOI] [PubMed] [Google Scholar]
- 17.Ueda M, Yonetsu K, Ohki M, Yamada T, Kitamori H, Nakamura T. Curvature analysis of the mandibular condyle. Dentomaxillofac Radiol 2003; 32: 87–92. doi: 10.1259/dmfr/23859709 [DOI] [PubMed] [Google Scholar]
- 18.Larheim TA. Role of magnetic resonance imaging in the clinical diagnosis of the temporomandibular joint. Cells Tissues Organs 2005; 180: 6–21. [DOI] [PubMed] [Google Scholar]
- 19.Limchaichana N, Petersson A, Rohlin M. The efficacy of magnetic resonance imaging in the diagnosis of degenerative and inflammatory temporomandibular joint disorders: a systematic literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 521–36. doi: 10.1016/j.tripleo.2006.02.001 [DOI] [PubMed] [Google Scholar]
- 20.Sanal HT, Bae WC, Pauli C, Du J, Statum S, Znamirowski R, et al. Magnetic resonance imaging of the temporomandibular joint disc: feasibility of novel quantitative magnetic resonance evaluation using histologic and biomechanical reference standards. J Orofac Pain 2011; 25: 345–53. [PMC free article] [PubMed] [Google Scholar]
- 21.Cholitgul W, Nishiyama H, Sasai T, Uchiyama Y, Fuchihata H, Rohlin M. Clinical and magnetic resonance imaging findings in temporomandibular joint disc displacement. Dentomaxillofac Radiol 1997; 26: 183–8. doi: 10.1038/sj.dmfr.4600239 [DOI] [PubMed] [Google Scholar]
- 22.Tasaki MM, Westesson PL, Isberg AM, Ren YF, Tallents RH. Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers. Am J Orthod Dentofacial Orthop 1996; 109: 249–62. doi: 10.1016/s0889-5406(96)70148-8 [DOI] [PubMed] [Google Scholar]
- 23.Yale SH, Allison BD, Hauptfuehrer JD. An epidemiological assessment of mandibular condyle morphology. Oral Surg Oral Med Oral Pathol 1966; 21: 169–77. doi: 10.1016/0030-4220(66)90238-6 [DOI] [PubMed] [Google Scholar]
- 24.Murakami S, Takahashi A, Nishiyama H, Fujishita M, Fuchihata H. Magnetic resonance evaluation of the temporomandibular joint disc position and configuration. Dentomaxillofac Radiol 1993; 22: 205–7. doi: 10.1038/dmfr.22.4.8181648 [DOI] [PubMed] [Google Scholar]
- 25.Amaral Rde O, Damasceno NN, de Souza LA, Devito KL. Magnetic resonance images of patients with temporomandibular disorders: prevalence and correlation between disk morphology and displacement. Eur J Radiol 2013; 82: 990–4. doi: 10.1016/j.ejrad.2013.01.002 [DOI] [PubMed] [Google Scholar]
- 26.Isberg A, Hägglund M, Paesani D. The effect of age and gender on the onset of symptomatic temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 252–7. doi: 10.1016/S1079-2104(98)90004-X [DOI] [PubMed] [Google Scholar]
- 27.Takatsuka S, Yoshida K, Ueki K, Marukawa K, Nakagawa K, Yamamoto E. Disc and condyle translation in patients with temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99: 614–21. doi: 10.1016/j.tripleo.2004.08.024 [DOI] [PubMed] [Google Scholar]
- 28.Campos MI, Campos PS, Cangussu MC, Guimarães RC, Line SR. Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle. Int J Oral Maxillofac Surg 2008; 37: 529–34. doi: 10.1016/j.ijom.2008.02.011 [DOI] [PubMed] [Google Scholar]
- 29.Okochi K, Ida M, Honda E, Kobayashi K, Kurabayashi T. MRI and clinical findings of posterior disk displacement in the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105: 644–8. doi: 10.1016/j.tripleo.2007.07.034 [DOI] [PubMed] [Google Scholar]
- 30.Whyte AM, McNamara D, Rosenberg I, Whyte AW. Magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement—a review of 144 cases. Int J Oral Maxillofac Surg 2006; 35: 696–703. doi: 10.1016/j.ijom.2005.12.005 [DOI] [PubMed] [Google Scholar]
- 31.Sato S, Sakamoto M, Kawamura H, Motegi K. Long-term changes in clinical signs and symptoms and disc position and morphology in patients with nonreducing disc displacement in the temporomandibular joint. J Oral Maxillofac Surg 1999; 57: 23–9. doi: 10.1016/S0278-2391(99)90625-0 [DOI] [PubMed] [Google Scholar]
- 32.Raustia AM, Pyhtinen J. Morphology of the condyles and mandibular fossa as seen by computed tomography. J Prosthet Dent 1990; 63: 77–82. doi: 10.1016/0022-3913(90)90271-d [DOI] [PubMed] [Google Scholar]
- 33.Solberg WK, Hansson TL, Nordström B. The temporomandibular joint in young adults at autopsy: a morphologic classification and evaluation. J Oral Rehabil 1985; 12: 303–21. doi: 10.1111/j.1365-2842.1985.tb01285.x [DOI] [PubMed] [Google Scholar]
- 34.Matsumoto K, Kameoka S, Amemiya T, Yamada H, Araki M, Iwai K, et al. Discrepancy of coronal morphology between mandibular condyle and fossa is related to pathogenesis of anterior disk displacement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116: 626–32. doi: 10.1016/j.oooo.2013.06.028 [DOI] [PubMed] [Google Scholar]
- 35.Vieira-Queiroz I, Gomes Torres MG, de Oliveira-Santos C, Flores Campos PS, Crusoé-Rebello IM. Biometric parameters of the temporomandibular joint and association with disc displacement and pain: a magnetic resonance imaging study. Int J Oral Maxillofac Surg 2013; 42: 765–70. doi: 10.1016/j.ijom.2013.01.004 [DOI] [PubMed] [Google Scholar]
- 36.Kurita H, Ohtsuka A, Kobayashi H, Kurashina K. Is the morphology of the articular eminence of the temporomandibular joint a predisposing factor for disc displacement? Dentomaxillofac Radiol 2000; 29: 159–62. doi: 10.1038/sj/dmfr/4600523 [DOI] [PubMed] [Google Scholar]
- 37.Almăşan OC, Hedeşiu M, Băciuţ G, Leucuţa DC, Băciuţ M. Disk and joint morphology variations on coronal and sagittal MRI in temporomandibular joint disorders. Clin Oral Investig 2013; 17: 1243–50. doi: 10.1007/s00784-012-0803-4 [DOI] [PubMed] [Google Scholar]
- 38.de Melo DP, Sousa Melo SL, de Andrade Freitas Oliveira LS, Ramos-Perez FM, Campos PS. Evaluation of temporomandibular joint disk displacement and its correlation with pain and osseous abnormalities in symptomatic young patients with magnetic resonance imaging. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119: 107–12. doi: 10.1016/j.oooo.2014.09.022 [DOI] [PubMed] [Google Scholar]