Orthodontics and temporomandibular joint internal derangement

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 9/18/2009
Article title: Orthodontics and temporomandibular joint internal derangement
Author(s): Katzberg RW, Westesson PL, et al.
Journal: Am J Orthod Dentofac Orthop
Volume (number): 109:515-20, 2006
Major topic: MRI’s of TMJ in symptomatic vs asymptomatic patients
Type of Article: Research article
Main Purpose: This study compared prevalence of internal derangement of the disc in TMJ of a symptomatic volunteers vs. symptomatic patients and to further compare them for a positive history of orthodontic treatment
Materials and Methods: 178 subjects were included in the study. 76 (39 female and 37 male) were asymptomatic volunteers and 102 (90 female and 12 male) were TMJ patients. An exam and history of TMJ pain, clicking, or tenderness were performed on all patients. An MRI of both TMJ’s in all patients were evaluated for disc displacement with and without reduction.
Findings: 25(33%) volunteers and 79 (77%) patients had at least one abnormal TMJ. Bilateral internal derangement was noted in 14% of volunteers and 51% of patients. The most common type of TMJ displacement was anterior displacement. A history of orthodontic treatment was present in both asymptomatic volunteers and TMJ patients. 33% of the asymptomatic volunteers with a normal TMJ scan, and 24% of the volunteers with anterior disc displacement had prior orthodontic treatment. In TMJ patients with anterior disc displacement, 20% had orthodontic treatment. In these symptomatic patients with a normal TMJ, 23% had orthodontic treatment. There was no relationship between asymptomatic and symptomatic patients and orthodontic treatment nor with disc displacement. Of note was a higher prevalence of TMJ displacement in asymptomatic volunteers then expected. As expected, there were significantly higher numbers of internal derangement amongst TMJ patients. A possible explanation for the higher then expected asymptomatic patients having disc displacement was that an MRI is more sensitive instrument in detecting the displacement. Lastly the data supports a very high prevalence in female as compared to males.
Key points/Summary : In summary, no relationship was found between orthodontic treatment and TMJ internal derangement.
Assessment of article: Good article that supports much of what Giannelly has spoken about in the past.