Emshoff Rüdiger, Bertram Felix, Schnabl Dagmar, Stigler Robert, Steinmaßl Otto, Rudisch Ansgar
Associate Professor, University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Candidate in Dental Medicine, Department of Prosthodontics, Philipps University, Marburg, Germany.
J Oral Maxillofac Surg. 2016 Jul;74(7):1343.e1-8. doi: 10.1016/j.joms.2016.01.029. Epub 2016 Jan 25.
The objective of this study was to assess the association between temporomandibular joint (TMJ) condylar erosion and chronic TMJ arthralgia.
Based on a sample size estimation, this case-and-control study involved 198 patients 16 to 73 years old recruited from a routine clinical practice (99 cases, patients with chronic TMJ arthralgia and mean pain duration of 16.4 months; 99 controls, asymptomatic patients without a history of orofacial pain). The clinical diagnosis of arthralgia was made according to the Research Diagnostic Criteria for Temporomandibular Disorders. Cone-beam computed tomographic (CBCT) images were evaluated for the presence or absence of erosive osseous changes of the TMJ condyle. Severity of TMJ condylar erosion was classified as grade 0 (absence of erosion), grade I (slight erosion), grade II (moderate erosion), or grade III (extensive erosion). Logistic regression analysis was used to assess the association between chronic TMJ arthralgia and condylar erosion, adjusting for age, gender, number of missing posterior teeth, and number of dental quadrants with missing posterior teeth.
TMJ condylar erosion was found in 59.6% of cases and 21.2% of controls. There was a significant association between TMJ arthralgia and degree of condylar erosion (P < .001). The odds ratio that a TMJ with condylar erosion grade II might belong to the TMJ arthralgia group was strong (3.1:1; 95% confidence interval [CI], 1.17 to 8.09) and significant (P = .023). Significant increases in risk of TMJ arthralgia occurred with condylar erosion grade III (7.7:1; 95% CI, 3.09 to 19.18; P < .001).
The study provides evidence of an association between TMJ condylar erosion and chronic TMJ arthralgia.
本研究的目的是评估颞下颌关节（TMJ）髁突侵蚀与慢性TMJ关节痛之间的关联。
基于样本量估计，本病例对照研究纳入了198例年龄在16至73岁之间的患者，这些患者来自常规临床实践（99例为慢性TMJ关节痛患者，平均疼痛持续时间为16.4个月；99例为对照，无症状且无口面部疼痛病史的患者）。关节痛的临床诊断根据颞下颌关节紊乱病研究诊断标准进行。对锥形束计算机断层扫描（CBCT）图像进行评估，以确定TMJ髁突是否存在侵蚀性骨质改变。TMJ髁突侵蚀的严重程度分为0级（无侵蚀）、I级（轻度侵蚀）、II级（中度侵蚀）或III级（广泛侵蚀）。采用逻辑回归分析评估慢性TMJ关节痛与髁突侵蚀之间的关联，并对年龄、性别、缺失后牙数量以及有缺失后牙的牙象限数量进行校正。
59.6%的病例和21.2%的对照中发现TMJ髁突侵蚀。TMJ关节痛与髁突侵蚀程度之间存在显著关联（P <.001）。髁突侵蚀为II级的TMJ属于TMJ关节痛组的优势比很强（3.1:1；95%置信区间[CI]，1.17至8.09）且具有显著性（P =.023）。髁突侵蚀为III级时，TMJ关节痛的风险显著增加（7.7:1；95%CI，3.09至19.18；P <.001）。
该研究提供了TMJ髁突侵蚀与慢性TMJ关节痛之间存在关联的证据。
