Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
Utredning av ansiktssmärta
2014-03-04
Diagnostic Criteria - Problems
•
•
•
•
•
Biobehavioral pain model
Reliability
Validity
Operationalization
Clinical relevance-treatment and prognosis
Most classification systems: one axis – one focus
– muscle or joint pain
Thomas List
Arne Petersson
Malmö University | Thomas List och Arne Petersson
2014-03-04
Comprises:
A dual axis approach.
• Clinical TMD Conditions (Axis I)
• Psychological disorders and psychosocial
dysfunction (Axis II)
Specifications for TMD Examination.
Strict diagnostic criteria.
Malmö University | Thomas List och Arne Petersson
2014-03-04
Malmö University | Thomas List och Arne Petersson
2014-03-04
Major steps from the RDC/TMD to the
DC/TMD
Research Diagnostic Criteria for
TMD (RDC/TMD)
RDC/TMD
Malmö University | Thomas List och Arne Petersson
2014-03-04
Year
Event
1992
Publication of RDC/TMD
2001-2008
Validation Project
2008
Symposium at IADR Conference (Toronto)
2009
International RDC/TMD Consensus Workshop at IADR
Conference (Miami)
2010
Publication of Major findings by Validation Project
2010
Symposium at IADR Conference (Barcelona)
2011
International RDC/TMD Consensus Workshop at IADR
Conference (San Diego). Expanded Taxonomy of DC/TMD
2012
Symposium of DC/TMD Conference at at IADR Conference
(Iguacu Falls). Expanded Taxonomy of DC/TMD
2013
Finalization of Expanded Taxonomy of DC/TMD at IADR
Conference (Seattle)
2014
Publication of DC/TMD and Expanded taxonomy of TMD
2014
Symposium of Expanded taxonomy of TMD at IADR
Conference (Cape Town).
Malmö University | Thomas List och Arne Petersson
2014-03-04
1
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
IADR Miami 2009
Description of the Workshop
International Consensus Workshop:
Convergence on an Orofacial Pain Taxonomy
•
• Workshop participation:
•
•
•
•
•
International RDC/TMD Consortium Network
SIG Orofacial Pain
NIDCR
American Academy of Orofacial Pain
European Academy of Craniomandibular
Disorders
• International Headache Society
• Other disciplines included: radiology, psychology,
ontology, neurology and patient advocacy.
Malmö University | Thomas List och Arne Petersson
2014-03-04
•
•
•
2014-03-04
Presentations: Systematic review
guidelines, biomedical ontology
and patient advocacy.
Workgroup made revisions of
respective parts of the
RDC/TMD
Each workgroup presented the
recommendations for critique by
the others.
Delphi-like voting for determing
whether sufficient concensus
had been achieved.
Malmö University | Thomas List och Arne Petersson
2014-03-04
Expanding the Scope of the Diagnostic Criteria for
Temporomandibular Disorders (DC/TMD)
Alla tillstånd
Represented Organizations
•
Expanded taxonomy
2014-03-04
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
IADR San Diego 2011
Diagnostik
Malmö University | Thomas List och Arne Petersson
•
•
•
•
•
International RDC/TMD
Consortium Network
IASP Orofacial Pain SIG
American Academy of Orofacial
Pain
European Academy of
Craniomandibular Disorders
International Headache Society
National Institute of Dental and
Craniofacial Research
I. TEMPOROMANDIBULAR JOINT DISORDERS
1 Joint pain
A Arthralgia
B Arthritis
2 Joint disorders
A Disc disorders
1 Disc displacement with reduction
2 Disc displacement with reduction with intermittent locking
3 Disc displacement without reduction with limited opening
4 Disc displacement without reduction without limited opening
B Hypomobility disorders other than disc disorders
1 Adhesions/Adherence
2 Ankylosis
a Fibrous
b Osseous
C Hypermobility disorders
1 Dislocations
a Subluxation
b Luxation
MALMÖ HÖGSKOLA
Malmö högskola | Orofaciala smärtenheten | Per Alstergren
2014-03-04
2
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
2014-03-04
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
3 Joint diseases
A Degenerative joint disease
1 Osteoarthrosis
2 Osteoarthritis
B Systemic arthritides
C Condylysis/Idiopathic condyle resorption
D Osteochondritis dissecans
E Osteonecrosis
F Neoplasm
G Synovial chondromatosis
4 Fractures
5 Congenital/developmental disorders
A Aplasia
B Hypoplasia
C Hyperplasia
II. MASTICATORY MUSCLE DISORDERS
III. HEADACHE
IV. ASSOCIATED STRUCTURES
1 Coronoid hyperplasia
Pain and headache location
DC/TMD Questionnaire
”Pain during the last 30 days”
Symptom questionnaire
Pain intensity
Limitation in daily activities
Jaw function
Psychosocial health
Pain drawing
Demographics
MALMÖ HÖGSKOLA
Malmö University | Thomas List och Arne Petersson
2014-03-04
Kalibrering
Maximum unassisted opening:
Decision trees
”I would like you to open your
mouth as wide as you can, even
if it is painful”
Pain
Familiar
Pain
Temporalis
N
Y
N
Y
Masseter
N
Y
N
Y
TMJ
N
Y
N
Y
Other M Musc
N
Y
N
Y
Non-mast
N
Y
N
Y
Malmö University | Thomas List och Arne Petersson
Familiar
Headache
N
Y
2014-03-04
Malmö University | Thomas List och Arne Petersson
2014-03-04
Malmö University | Thomas List och Arne Petersson
2014-03-04
3
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
2014-03-04
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
Myalgia
I. TEMPOROMANDIBULAR JOINT DISORDERS
1 Joint pain
A Arthralgia
B Arthritis
2 Joint disorders
A Disc disorders
1 Disc displacement with reduction
2 Disc displacement with reduction with intermittent locking
3 Disc displacement without reduction with limited opening
4 Disc displacement without reduction without limited opening
B Hypomobility disorders other than disc disorders
1 Adhesions/Adherence
2 Ankylosis
a Fibrous
b Osseous
C Hypermobility disorders
1 Dislocations
a Subluxation
b Luxation
Sensitivity 0.84; Specificity 0.95
History:
1. Pain in the jaw, temple, in the ear, or in front of ear;
AND
2. Pain modified with jawe movement, function or
parafunction. AND
Exam:
1. Confirmation of pain location in the area of the
temporalis or masseteer muscle(s); AND
2. Report of familiar pain in the temporalis or masseter
with at least 1 of the following provocation tests:
a. Palpation of the temporalis or masseter muscles(s);
OR
b. Maximum unassisted or assisted opening.
Arthralgia
Sensitivity 0.91; Specificity 0.96
History:
1. Pain in the jaw, temple, in the ear, or in front of ear;
AND
2. Pain modified with jaw movement, function or
parafunction.
AND
Exam:
1. Confirmation of pain location in the area of the TMJ(s);
AND
2. Report of familiar pain in the TMJ with at least 1 one
of the following provocation tests:
a. Palpation ofthe lateral pole; OR
b. Maximum unassisted or assisted opening, right or
left lateral movements, or protrusive movements.
MALMÖ HÖGSKOLA
Malmö University | Thomas List och Arne Petersson
2014-03-04
Malmö University | Thomas List och Arne Petersson
2014-03-04
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
Palpation TMJ joint
TMJ
Pain
Lateral pole (0,5 kg)
Malmö University | Thomas List och Arne Petersson
Familiar
Pain
Referred
Pain
N
Y
N
Y
N
Around lateral pole (1kg) N
Y
N
Y
N
Y
Y
I. TEMPOROMANDIBULAR JOINT DISORDERS
1 Joint pain
A Arthralgia
B Arthritis
2 Joint disorders
A Disc disorders
1 Disc displacement with reduction
2 Disc displacement with reduction with intermittent locking
3 Disc displacement without reduction with limited opening
4 Disc displacement without reduction without limited opening
B Hypomobility disorders other than disc disorders
1 Adhesions/Adherence
2 Ankylosis
a Fibrous
b Osseous
C Hypermobility disorders
1 Dislocations
a Subluxation
b Luxation
MALMÖ HÖGSKOLA
Disc Displacement with Reduction
(Sensitivity 0.80; specificity 0.97 without imaging)
History is positive for at least one of the following:
1. In the last 30 days, any TMJ noises(s)present with
jaw movements or function; OR
2. Patient report of any noise present during exam; AND
Examination is positive at least for one of the following:
1. Clicking popping, and/or snapping noise detected during both opening
and closing movements, detected by palpation during at least one of
three repetitions of jaw opening and closing movements; OR
2a. Clicking popping, and/ or snapping noise detected with palpation during
at least one of three repetitions of opening and closing
movements(s);AND
2b. Clicking popping, and/ or snapping noise detected with palpation during
at least one of three repetitions of right and left lateral or protrusive
movement(s).
2014-03-04
4
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
Disc Displacement without Reduction
with Limited Opening (DC/TMD)
(Sensitivity 0.80; specificity 0.97 without imaging)
2014-03-04
Normal disc position closed mouth sagittal and coronal
views (Ahmad et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
DISC DISORDERS
2009;107:844-860)
Imaging: Diagnostic imaging should only be
considered after a history and physical
examination, indicates that information from
imaging will influence patient care. Further
research is needed.
I. History is positive for both of the
following:
1. Jaw lock or catch so that it would not
open all the way; AND
2. Limitation in jaw opening severe enough
to interfere with ability to eat.
AND
II. Examination is positive for the following:
1.Maximum assisted opening (passive
stretch)
< 40mm. Including vertical incisal overlap.
MRI is the prefered modality
Peck et al. 2014
MALMÖ HÖGSKOLA
i. In the sagittal plane, relative to the superior aspect of the condyle, the border between the
low signal of the disc and the high signal of the retrodiscal tissue is located between the
11:30 and 12:30 clock positions; and
ii. In the sagittal plane, the intermediate zone is located between the anterior-superior aspect of
the condyle and the posterior-inferior aspect of the articular eminence; and
iii. In the oblique coronal plane, the disc is centered between the condyle and eminence in the
medial, central, and lateral parts.
MALMÖ HÖGSKOLA
Disc displacement
Proton density, Sagittal,
Closed mouth
Normal disc position
T2
(Ahmad et al. 2009)
Proton density
Coronal
Closed mouth
Westesson 1982
i. In the sagittal plane, relative to the superior aspect of the condyle, the low signal of the disc and the
high signal of the retrodiscal tissue are located anterior to the 12:30 clock position; and
ii. In the sagittal plane, the intermediate zone of the disc is located anterior to the condyle; or
iii. In the axially corrected coronal plane, the disc is not centered between the condyle and
eminence in either the medial or the lateral parts.
MALMÖ HÖGSKOLA
5
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
Closed mouth
Disc displacement
Proton density, Coronal
2014-03-04
T2
Disc position: open-mouth sagittal views
Closed mouth
(Ahmad et al. 2009)
Lateral disc displacement
Normal disc position: The intermediate zone is
located between the condyle and the articular
eminence.
Persistent disc displacement: The intermediate
zone is located anterior to the condylar head.
MALMÖ HÖGSKOLA
Proton density
Sagittal
Open mouth
Normal disc
position
Closed mouth
Disc displacement
Open mouth
Without reduction
Disc diagnosis for TMJ (Ahmad et al. 2009)
A. Normal: Disc location is normal on closed- and
open-mouth images.
B. Disc displacement with reduction: Disc location is
displaced on closed-mouth images but normal in
open-mouth images.
C. Disc displacement without reduction: Disc
location is displaced on closed-mouth and openmouth images.
D. Indeterminate: Disc location is not clearly normal
or displaced in the closed-mouth position.
E. Disc not visible
MALMÖ HÖGSKOLA
6
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
MRT
MRI
1.5 - 3 Tesla
Axially corrected sagittal and coronal images
Closed and open mouth positions
Proton-density PD or T1, and T2
MALMÖ HÖGSKOLA
Proton density
T2
1. Diskens läge
2. Diskens form
Normal: Bikonkav i sagitalplanet
Deformerad: Alla andra former än bikonkav
Disk går ej att identifiera
3. Effusion-ledvätska
Ingen: Ingen förhöjd signal i ledrummen vid T2-viktade bilder
Lätt (slight) effusion: En förhöjd signal i något av ledrummen som håller
sig längs konturerna av disken, fossa, tuberkeln eller condylen
Kraftig (frank) effusion: En förhöjd signal i något av ledrummen som
sträcker sig utanför de osseösa konturerna av fossa, tuberkeln,
condylen och som har en konvex konfiguration I den anteriora eller
posteriora recessen
4. Förkalkningar i leden
5. Osseösa förändringar (erosion, osteofyt, subchondral cysta, avplaning)
6. Benmärgsförändringar (ödem, scleros)
MALMÖ HÖGSKOLA
The Efficacy of Diagnostic Imaging
Fryback & Thornbury (1991)
6
TMJ disc position
5
Societal
3
Patient outcome
2
Therapeutic
1
Diagnostic thinking
Diagnostic accuracy
Technical
TMJ disc position
(Limchaichana et al. 2006)
4
Efficacy levels
MALMÖ HÖGSKOLA
2014-03-04
Sensitivity and specificity
7 publications moderate and 7 low levels of evidence.
Diagnostic criteria and disease prevalences varied
substantially.
Sagittal images: sensitivity 0.86, specificity 0.63
Coronal images: sensitivity 0.50-0.87, specificity 0.800.92
Combining sagittal and coronal images: sensitivity
0.60-0.90, specificity 0.92-1.0
MALMÖ HÖGSKOLA
Observer performance (Limchaichana et al. 2006)
4 publications with moderate level of evidence
Intraobserver agreement Kappa mean, 0.85 good
Interobserver agreement very good for high quality images and
disk displacement without reduction (Kappa 0.91), and poor
for slight anterior disk displacement (Kappa 0.19).
Interobserver agreement - Kappa; (Ahmad et al. 2009)
Any disc displacement 0.84
Disc displacement with reduction 0.78
Disc displacement without reduction 0.94
MALMÖ HÖGSKOLA
7
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
Web-based calibration of observers using MRI
of the temporomandibular joint
The efficacy of magnetic resonance imaging in the
diagnosis of degenerative and inflammatory
temporomandibular joint disorders: a systematic
literature review.
Hellén-Halme, Hollender, Janda, Petersson. Dentomaxillofac Radiol
2012; 41, 656–661.
Limchaichana et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2006;102:521-36.
http://www.mah.se/od/rad/tmj
MALMÖ HÖGSKOLA
• No publication had a high level of evidence
• No publication reported diagnostic thinking
efficacy or therapeutic efficacy
• The evidence grade for diagnostic accuracy
expressed as sensitivity, specificity, and predictive
values was limited to insufficient
MALMÖ HÖGSKOLA
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
Degenerative joint disease
(Sensitivity 0.55; specificity 0.61 without imaging)
I. History is positive for at least one of the following:
1. In the last 30 days, any TMJ noises(s)present with
jaw movements or function; OR
2. Patient report of any noise present during exam.
AND
II. Examination is positive at least for one of the following:
1. Crepitus detected with palpation during at least one
of the following; opening, closing, right or left lateral
or protrusive movements (s).
Degenerative joint disease (DJD)
• Deterioration of articular tissue with osseous changes. DJD can
be sub-classified as:
Osteoarthrosis - DJD without arthralgia
Osteoarthritis – DJD with arthralgia
• Flattening and and /or subcortical sclerosis are considered
indeterminant findings for DJD and may represent normal
variation, aging, remodelling or a precursor to frank DJD.
Imaging: When this diagnosis needs to be confirmed.
TMJ CT/CBCT criteria are positive for at least one of the following:
1. Subchondral cyst 2. Erosion(s) 3. Generalized sclerosis 4.
Osteophyte(s)
MALMÖ HÖGSKOLA
2014-03-04
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
3 Joint diseases
A Degenerative joint disease
1 Osteoarthrosis
2 Osteoarthritis
B Systemic arthritides
C Condylysis/Idiopathic condyle resorption
D Osteochondritis dissecans
E Osteonecrosis
F Neoplasm
G Synovial chondromatosis
4 Fractures
5 Congenital/developmental disorders
A Aplasia
B Hypoplasia
C Hyperplasia
II. MASTICATORY MUSCLE DISORDERS
III. HEADACHE
IV. ASSOCIATED STRUCTURES
1 Coronoid hyperplasia
MALMÖ HÖGSKOLA
Osseous diagnoses. Ahmad et al. 2009
A. No osteoarthritis
i. Normal relative size of the condylar head; and
ii. No subcortical sclerosis or articular surface flattening; and
iii. No deformation due to subcortical cyst, surface erosion,
osteophyte, or generalized sclerosis.
B. Indeterminate for osteoarthritis
i. Normal relative size of the condylar head; and
ii. Subcortical sclerosis with/without articular surface flattening;
or
iii. Articular surface flattening with/without subcortical sclerosis;
and
iv. No deformation due to subcortical cyst, surface erosion,
osteophyte, or generalized sclerosis.
C. Osteoarthritis
i. Deformation due to subcortical cyst, surface erosion,
osteophyte, or generalized sclerosis.
MALMÖ HÖGSKOLA
8
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
2014-03-04
Osseous changes. Diagnostic accuracy.
CBCT of condyle.
Hintze et al. 2007
Sensitivity
Lateral Frontal
Specificity
Lateral Frontal
Flattening
0,23
0,40
0,87
0,90
Defect
0,15
0,20
0,95
0,96
Osteophyte
0,15
Honda et al. 2006
0,96
0,80
• To test changes in diagnosis
and management after
radiographic examination
• To evaluate the associations
between specific findings in
TMJ tomograms and changes in
management strategy.
Ahmad et al. 2009
Kappa
Panoramic radiography 0.27
MRI 0.58
CT 0.71
1,0
MALMÖ HÖGSKOLA
Hur påverkas diagnos och behandlingsval av
röntgenfynden vid TMD?
Osseous changes. Observer agreement.
MALMÖ HÖGSKOLA
Diagnostic thinking
Therapeutic thinking
The diagnosis (RDC/TMD) was changed in 27% of
the patients after tomography, often arthralgia >
osteoarthritis
Choice of treatment with and without tomography.
3 clinics.
The choice of treatment was changed in 27% of the
patients – mostly slight changes in medication and
fysiotherapy.
Wiese 2008
Differences existed between the clinics
MALMÖ HÖGSKOLA
MALMÖ HÖGSKOLA
MALMÖ HÖGSKOLA
Wiese 2008
9
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
2014-03-04
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
3 Joint diseases
A Degenerative joint disease
1 Osteoarthrosis
2 Osteoarthritis
B Systemic arthritides
C Condylysis/Idiopathic condyle resorption
D Osteochondritis dissecans
E Osteonecrosis
F Neoplasm
G Synovial chondromatosis
4 Fractures
5 Congenital/developmental disorders
A Aplasia
B Hypoplasia
C Hyperplasia
II. MASTICATORY MUSCLE DISORDERS
III. HEADACHE
IV. ASSOCIATED STRUCTURES
1 Coronoid hyperplasia
Systemic arthritides
Systemic Arthritides
Note that imaging in early stages of the disease may not
demonstrate any osseous findings.
History positive for both of the following:
1. Rheumatic diagnosis of a systematic inflammatory
joint disease, AND
2a. Pain in the jaw, temple, in the ear, or in front of ear;
AND
2b. Pain modified with jaw movement, function or
parafunction; AND
Imaging
If osseous changes are present, TMJ CT/CBCT or MR imaging is
positive for at least one of the following:
1. Subchondral cyst(s)
2. Erosion(s)
3. Generalized sclerosis
4. Osteophyte(s)
Examination positive for both of the
following
1. Rheumatic diagnosis of a systematic joint disease; AND
2a. Arthritis signs and symptoms as deined in I.1.B; OR
2b. Crepitus detected with palpation during maximum
unassisted opening, maximum assisted opening, right
or left lateral movements, or protrusive movements.
MALMÖ HÖGSKOLA
MALMÖ HÖGSKOLA
Malmö University | Thomas List och Arne Petersson
2014-03-04
Expanded Taxonomy for Temporomandibular Disorders
Peck et al. J Oral Rehab 2014; 41: 2-23.
Åkerman et al. (1991). Nittio patienter med RA. 2/3 uppvisade
röntgenförändringar i käklederna, oftast erosioner jämförbara
med förändringarna i händer och fötter.
3 Joint diseases
A Degenerative joint disease
1 Osteoarthrosis
2 Osteoarthritis
B Systemic arthritides
C Condylysis/Idiopathic condyle resorption
D Osteochondritis dissecans
E Osteonecrosis
F Neoplasm
G Synovial chondromatosis
4 Fractures
5 Congenital/developmental disorders
A Aplasia
B Hypoplasia
C Hyperplasia
II. MASTICATORY MUSCLE DISORDERS
III. HEADACHE
IV. ASSOCIATED STRUCTURES
1 Coronoid hyperplasia
MALMÖ HÖGSKOLA
10
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
Synovial chondromatosis
SBU: Synovial chondromatos är en benign sjukdom
som innebär att ledhinnan i käkleden bildar fria
broskkroppar. Tillståndet behandlas t ex med
käkledkirurgi.
Socialstyrelsen: Tillståndet innebär en mycket stor
påverkan på den orala hälsan till följd av en stor
grad av vävnadsskada
2014-03-04
Synovial chondromatosis
Synovial Chondromatosis
Imaging: TMJ MRI or CT/CBCT is positive for at least
one of the following:
1. MRI: multiple chondroid nodules, joint effusion
and amorphous iso-intensity signal tissues
within the joint space and capsule
2. CT/CBCT: loose calcified bodies in the soft tissues
of the TMJ
History positive for at least one of the
following:
1. Report of preauricular swelling; OR
2. Arthralgia as defined in I.1.A; OR
3.Progressive limitation in mouth opening; OR
4. In the past month, any joint noise(s) present
II. Examination positive for at least one of
the following:
1. Preauricular swelling; OR
2. Arthralgia as defined in I.1.A; OR
3. Maximum assisted opening< 40 mm including vertical
overlap; OR
4. Crepitus as per I3.A (DJD)
MALMÖ HÖGSKOLA
MALMÖ HÖGSKOLA
Malmö University | Thomas List och Arne Petersson
2014-03-04
Synovial chondromatos
Synovial chondromatos
Case
Arne has pain in the first molar in his upper left
jaw. Tooth 27 was extracted by another dentist
because of a crack. Since the pain did not go
away, tooth 26 was then endodontically
treated several times,
but the pain is unchanged.
What do you do?
11
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
2014-03-04
touch
Pin-prick
Definition Atypical Odontalgia
Pressure pain
• Pain located in a region where a tooth has
been endodontically or surgically treated
temperature
• Chronic pain (> 6 months)
• No pathological cause detectable in clinical
or radiological examination.
• Synonyms: phantom tooth pain, idiopathic
toothache, CCDAP
Malmö University | Thomas List och Arne Petersson
2014-03-04
Malmö University | Thomas List och Arne Petersson
2014-03-04
CBCT
31
Atypisk Odontalgi
A comparative analysis of MRI and radiographic examinations of
patients with atypical odontalgia. Pigg, List, Abul-Kasim, Maly, Petersson.
J Orofacial Pain 2014.
MRT T1 fs gd
MRT T2 stir
n (%)
+
–
Total
+
6 (30)
2 (10)
8 (40)
–
3 (15)
9 (45)
12 (60)
Total
9 (45)
11 (55)
20 (100)
32
CBCT
20 patienter diagnosticerade med atypisk odontalgi. Patienterna är
undersökta med intraorala röntgenbilder, panoramaröntgen, CBCT och
MRT med T1, T2 STIR, (3D CISS), T1 gd, T1 fs gd
Radiographic bone defect
Pigg et al2014-03-04
2010
Malmö University | Thomas List och Arne Petersson
MRT T1
MRT T2 stir
MRI changes
in signal
n (%)
MALMÖ HÖGSKOLA
12
Per Alstergren: The temporomandibular joint. Oral Neuroscience
Course 2010
CBCT
MRT T2 stir
MRT T1 fs gd
Atypisk Odontalgi
2014-03-04
DC/TMD i Grundutbildningen och
Specialistutbildningen
• MRT visade inga signalförändringar i smärtregionen hos
majoriteten av patienterna (60%)
• Fynden vid MRT och CBCT var signifikant korrelerade och
gav samma resultat hos 75% av patienterna
När röntgenfynden är osäkra, speciellt i regioner där ett
flertal behandlingar har genomförts, kan MRT styrka
argumentet att undvika vidare tandbehandling. Fler studier
behövs för att utreda nyttan av MRT.
MALMÖ HÖGSKOLA
Malmö University | Thomas List och Arne Petersson
2014-03-04
RDC/Orofacial Pain
Axis I : Diagnosis
Axis II: Psychosocial assessment
Axis III: Biomarkers
13