Orthodontic Resident, Section of Orthodontics, Aarhus University, Aarhus, Denmark.
Professor, Section of Orthodontics, Aarhus University, Aarhus, Denmark and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
J Oral Maxillofac Surg. 2021 Apr;79(4):774-785. doi: 10.1016/j.joms.2020.10.032. Epub 2020 Oct 23.
This cross-sectional study compared orofacial manifestations at the time of diagnosis in 2 temporomandibular joint (TMJ) conditions: adolescent idiopathic condylar resorption (ICR) and TMJ involvement from juvenile idiopathic arthritis (JIA).
This retrospective study included 19 JIAs, 19 ICRs, and 19 control patients, all treated at the Section of Orthodontics, Aarhus University Craniofacial Clinic, Denmark. From patient files, we retrieved radiological data from cone-beam computed tomographies along with information on symptoms and orofacial function at the time of diagnosis. Validated methodologies were used to evaluate TMJ and dentofacial morphology.
We found no statistically significant intergroup differences in severity of deformation of TMJ structures (TMJ deformity) between JIA and ICR patients. However, the ICR group showed significantly greater signs of dentofacial deformity on 4 outcome variables: mandibular inclination, posterior/anterior lower face height ratio, mandibular sagittal position, and mandibular occlusal plane inclination. Significant intergroup differences in clinical presentation were seen in 5 of 20 variables. Thus, the JIA group reported significantly more symptoms of TMJ pain, TMJ morning stiffness, and TMJ pain on palpation during the clinical examination, whereas the ICR group reported significantly more TMJ clicking during function and had a higher proportion of patients with anterior open bite.
Cone-beam computed tomography examination showed a similar degree of TMJ deformity in ICR and JIA patients at the time of diagnosis. ICR patients presented with a significantly higher degree of dentofacial deformity than JIA patients and healthy controls, which relates to the timing of the diagnosis. Arthralgia, TMJ morning stiffness, and TMJ palpitation pain were more common in JIA patients, whereas TMJ clicking during function and anterior open bites were more common in ICR patients.
本横断面研究比较了两种颞下颌关节（TMJ）疾病的诊断时的颌面部表现：青少年特发性髁突吸收（ICR）和青少年特发性关节炎（JIA）累及 TMJ。
本回顾性研究纳入了丹麦奥胡斯大学颅面诊所正畸科治疗的 19 例 JIA、19 例 ICR 和 19 例对照组患者。我们从患者档案中获取了锥形束 CT 的放射学数据，以及诊断时的症状和颌面部功能信息。采用了经过验证的方法来评估 TMJ 和牙颌面形态。
我们发现 JIA 和 ICR 患者的 TMJ 结构变形（TMJ 畸形）严重程度在组间无统计学差异。然而，ICR 组在 4 个结果变量上表现出更显著的牙颌面畸形迹象：下颌倾斜度、后/前下面高比、下颌矢状位置和下颌咬合平面倾斜度。20 个变量中有 5 个在组间有显著差异。因此，JIA 组在临床检查中报告的 TMJ 疼痛、TMJ 晨僵和 TMJ 触诊痛的症状明显更多，而 ICR 组在功能时报告的 TMJ 弹响明显更多，且有更多的患者存在前牙开颌。
锥形束 CT 检查显示，在诊断时，ICR 和 JIA 患者的 TMJ 畸形程度相似。ICR 患者的牙颌面畸形程度明显高于 JIA 患者和健康对照组，这与诊断时间有关。JIA 患者更常见的是关节痛、TMJ 晨僵和 TMJ 触诊痛，而 ICR 患者更常见的是功能时的 TMJ 弹响和前牙开颌。
