8/9/2019 Pilihan Rontgen TMJ.htm

1/10

Diagnostic Imaging of theTemporomandibular Joint

TEXT SIZE

By: C. Grace Petrikowski, DDS, MSc, FRCD(C)2005-06-01

Temporomandibular joint dysfunction (TMD) can aect a signicant portion of t!e population"#$linical symptoms may include one or more of t!e follo%ing& pain in t!e region of t!etemporomandibular joint (TM') !eadac!es earac!es muscle tenderness joint noises suc! asclicing popping or grating limited opening or de*iation of t!e mandible on opening+closinglocing and occlusal c!anges due to alteration in mandibular positioning" E*aluation of TMD begins%it! a t!oroug! patient !istory and clinical e,amination" In some cases t!e clinical e,aminationndings are su-cient to allo% t!e dentist to arri*e at a preliminary diagnosis and beginconser*ati*e treatment" .o%e*er ot!er patients %ill re/uire diagnostic imaging of t!e TM's inorder to pro*ide information %!ic! is not a*ailable from t!e clinical e,amination"

Indications for TM' imaging include t!e follo%ing& conser*ati*e treatment t!at !as failed orsymptoms are %orsening patients %it! a !istory of trauma signicant dysfunction sensory ormotor abnormalities signicant c!anges in occlusion or if an osseous abnormality or infection issuspected"0 Some practitioners order TM' imaging if t!ere is a !istory of TMD and t!e treatmentplan includes e,tensi*e reconstructi*e %or or ort!odontia since t!ese types of treatment cansignicantly alter t!e occlusion and predispose t!e patient to a recurrence of t!eir TMD symptoms"Imaging allo%s t!e practitioner to e*aluate t!e integrity and relations!ips of t!e TM' osseouscomponents conrm t!e e,tent or progression of joint disease and e*aluate eects of treatment"1

T!e results of imaging studies must be correlated %it! t!e patient !istory and clinical ndings inorder to arri*e at a diagnosis and plan treatment" T!e purpose of t!is article is to re*ie% current

TM' imaging tec!ni/ues so t!at t!e dental practitioner understands t!e contribution imaging canmae to t!e diagnosis of TMD"

T!e c!oice of imaging tec!ni/ue %ill depend on t!e specic clinical problem %!et!er !ard or softtissues %ill be imaged radiation dose cost a*ailability of t!e imaging tec!ni/ue and t!e amountof diagnostic information pro*ided by t!e tec!ni/ue"1 T!ere !a*e been considerable ad*ances inimaging tec!nology to reduce radiation dose and a*ailability of imaging continues to impro*e"2sually t!e !ard tissues are imaged rst to e*aluate osseous contours positional relations!ip oft!e condyle and glenoid fossa and range of motion" Soft tissue imaging is indicated %!eninformation about dis position or morp!ology is needed or to image abnormalities in t!esurrounding muscles or soft tissues"

Images s!ould depict t!e entire joint and surrounding structures" Ideally images s!ould bea*ailable in a minimum of t%o planes perpendicular to eac! ot!er suc! as t!e lateral and frontalplanes" 3ie%s at additional orientations may also be useful allo%ing t!ree4dimensional assessment

of t!e joint" $onsideration s!ould also be gi*en to imaging structures furt!er remo*ed from t!eTM' particularly if t!e TM' ndings are normal since t!e etiology for t!e patient5s symptoms mayin fact be from a source remote from t!e TM'"

HARD TISSUE IMAGING

Panoramic radiography

6 panoramic radiograp! is considered a 7screening7 projection and is often used in combination%it! ot!er !ard tissue imaging tec!ni/ues to image t!e TM's"8 (9ig #a)" It gi*es an o*er*ie% of t!e

ja%s and teet! allo%ing e*aluation of mandibular symmetry t!e ma,illary sinuses and t!edentition" Mandibular asymmetries may not be clinically apparent and a discrepancy in si:e of one

condyle or one side of t!e mandible may be a contributing factor in t!e de*elopment of TMD";4