Η συμβολή του οδοντιατρικού υπολογιστικού τομογράφου στη διάγνωση της οστεοαρθρίτιδας της ΚΓΔ. Περιγραφή περιπτώσεων
Κωνσταντίνα-Ελένη ΑΛΕΞΙΟΥ1, Χαράλαμπος ΣΤΑΜΑΤΑΚΗΣ2, Κώστας ΤΣΙΧΛΑΚΗΣ3
Τμήμα Διαγνωστικής και Ακτινολογίας Στόματος, Οδοντιατρική Σχολή Πανεπιστημίου Αθηνών
(Διευθυντής: Καθηγητής Κ. Τσιχλάκης)
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής (2009) 2, 91-99
ΠΕΡΙΛΗΨΗ: Η Οδοντιατρική Υπολογιστική Τομογραφία είναι η μέθοδος εκλογής για την απεικόνι-
ση και αξιολόγηση των οστεοαρθριτικών αλλοιώσεων της κροταφογναθικής διάρθρωσης λόγω της
χαμηλής δόσης ακτινοβολίας που λαμβάνει ο ασθενής σε συνδυασμό με την πολύ υψηλής διαγνω-
στικής αξίας απεικόνιση της ΚΓΔ.
Σκοπός το άρθρου αυτού είναι η παρουσίαση περιστατικών ασθενών με σημεία και συμπτώματα
από τις ΚΓΔ, όπου ο απεικονιστικός έλεγχος με τον Οδοντιατρικό Υπολογιστικό Τομογράφο έπαι-
ξε καθοριστικό ρόλο στη διάγνωση οστεοαρθρίτιδας.
ΛΕΞΕΙΣ ΚΛΕΙΔΙΑ: Κροταφογναθική διάρθρωση, Οστεοαρθρίτιδα, Οδοντιατρικός υπολογιστικός
τομογράφος
REFERENCES
Alexiou KE, Stamatakis HC, Tsiklakis K: Evaluation of the
severity of Temporomandibular Joint osteoarthritic
changes related to age using Cone Beam CT.
Dentomaxillofac Radiol 38:141-147, 2009
Arai Y, Tammisalo E, Iwai K, Hashimoto K, Shinoda K:
Development of a compact computed tomographic
apparatus for dental use. Dentomaxillofac Radiol
28:245-248, 1999
Araki K, Maki K, Seki K, Sakamaki K, Harata Y, Sakaino R,
Okano T, Seo K: Characteristics of a newly developed
dentomaxillofacial X-ray cone beam CT scanner (CB
MercuRay): system configuration and physical
properties. Dentomaxillofac Radiol 33:51-59, 2004
Benson BW, Otis LL: Disorders of the temporomandibular
joint. Dent Clin North Am 38:167-185, 1994
Bertram S, Rudisch A, Innerhofer K, Pumpel E, Grubwieser
G Emshoff R: Diagnosing TMJ internal derangement
and osteoarthritis with magnetic resonance imaging.
Journal of American Dental Association 132:753-761,
2001
Brandlmaier I, Bertram S, Rudisch A, Bodner G, Emshoff R:
Temporomandibular joint osteoarthrosis diagnosed
with high resolution ultrasonography versus magnetic
resonance imaging: how reliable is high resolution
ultrasonography? J Oral Rehabil 30:812-817, 2003
Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG,
Omnell KA, Westesson PL, White SC: Imaging of the
temporomandibular joint: a position paper of the
American Academy of Oral and Maxillofacial Radiology.
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod. 83:609-618, 1997
Cholitgul W, Petersson A, Rohlin M, Tanimoto K,
Akerman S: Diagnostic outcome and observer performance
in sagittal tomography of the temporomandibular
joint. Dentomaxillofac Radiol 19:1-6, 1990
Cohnen M, Kemper J, Mobes O, Pawelzik J, Modder U:Radiation dose in dental radiology. Eur Radiol 12:634-
637, 2002
Delbalso A: Maxillofacial Imaging. W. B. Saunders Company,
1990, pp. 624-632.
Emshoff R, Brandimaier I, Bertram S, Rudisch A: Magnetic
resonance imaging findings of osteoarthrosis and effusion
in patients with unilateral temporomandibular
joint pain. Int J Oral Maxillofac Surg 31:568-602, 2002
Emshoff R, Rudisch A: Are internal derangement and osteoarthrosis
linked to changes in clinical outcome measures
of arthrocentisis of the temporomandibular
joint? J Oral and Maxillofac Surg 61:1162-1167, 2003
Gynther GW, Tronje G, Holmlund AB: Radiographic
changes in the temporomandibular joint in patients
with generalized osteoarthritis and rheumatoid
arthritis. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 81:613-618, 1996
Gynther GW, Tronje G: Comparison of arthroscopy and
radiography in patients with temporomandibular joint
symptoms and generalized arthritis. Dentomaxillofac
Radiol 27:107-112, 1998
Hansson LG, Hansson T, Petersson A: A comparison between
clinical and radiologic findings in 259 temporomandibular
joint patients. J Prosthet Dent 50:89-94,
1983
Holmund A, Hellsing G: Arthroscopy of the temporomandibular
joint. A comparative study of arthroscopic
and tomographic findings. Int J Oral Maxillofac Surg
128-133, 1988
Honda K, Larheim TA, Maruhashi K, Matzumoto K and
Iwai K: Osseous abnormalities of the mandibular condyle:
diagnostic reliability of cone beam computed
tomography compared with helical computed tomography
based on an autopsy material. Dentomaxillofac
Radiol 35:152-157, 2006
Ishibashi H, Takenoshita Y, Ishibashi K, Oka M: Agerelated
changes in the human mandibular condyle: a
morphologic, radiologic, and histologic study. J Oral
Maxillofac Surg 53:1016-1023, 1995
Kazuya H, Tore A.L, Johannessen S, Arai Y, Shinoda K,
Westesson P-L: Ortho cubic super-high resolution
computed tomography: A new radiographic technique
with application to the temporomandibular joint. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 91:239-
243, 2001
Lascala CA, Panella J, Marques MM: Analysis of the
accuracy of linear measurements obtained by cone
beam computed tomography (CBCT-NewTom).
Dentomaxillofac Radiol 33:291-294, 2004
Ludlow JB, Davies-Ludlow LE, Brooks SL: Dosimetry of
two extraoral direct digital imaging devices: NewTom
cone beam CT and Orthophos Plus DS panoramic
unit. Dentomaxillofac Radiol 32:229-234, 2003
Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB:
Dosimetry of 3 CBCT devices for oral and maxillofacial
radiology: CB MercuRay, NewTom 3G and i-
CAT. Dentomaxillofac Radiol 35:219-226, 2006
Mah J, Hatcher D: Three-dimentional craniofacial imaging.
Am J of Orthod Dentofacial Orthop 126:308-309,
2004
Mah JK, Danforth RA, Bumann A, Hatcher D: Radiation
absorbed in maxillofacial imaging with a new dental
computed tomography device. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 96:508-513, 2003
Martinez–Blanco M., Bagan JV, Fons A., Poveda – Roda R:
Osteoarthrosis of the temporomandibular joint. A
clinical and radiological study of 16 patients. Med Oral
9:106-115, 2004
Melchiorre D, Calderazzi A, Maddali Bongi S, Cristofani R,
Bazzichi L, Eligi C, Maresca M, Ciompi M: A comparison
of ultrasonography and magnetic resonance imaging
in the evaluation of temporomandibular joint
involvement in rheumatoid arthritis and psoriatic
arthritis. Rheumatology (Oxford) 42:673-676, 2003
Miles D, Van Dis M, Kaugars G, Lovas J: Oral & Maxillofacial
Radiology. Radiologic / Pathologic Correlations. W.B.
Saunders Company 1991, pp. 275-281
Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA: A
new volumetric CT machine for dental imaging based
on the cone-beam technique: preliminary results. Eur.
Radiol 8:1558-1564, 1998
Nilner M, Petersson A: Clinical and radiological findings
related to treatment outcome in patients with temporomandibular
disorders. Dentomaxillofac Radiol 24:
128-131, 1995
Roberts D, Pettigrew J, Udupa J, Ram C: Three-dimensional
imaging and display of the temporomandibular
joint. Oral Surg 58:461-474, 1984
Sukovic P: Cone beam computed tomography in craniofacial
imaging. Orthod. Craniofacial Res 6:31-36,
2003
Sulun T, Cemgil T, Duc JM, Rammelsberg P, Jager L,
Gernet W: Morphology of the mandibular fossa and
inclination of the articular eminence in patients with
internal derangement and in symptom-free volunteers.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
92:98-107, 2001
Toure G, Duboucher C, Vacher C: Anatomical modifications
of the temporomandibular joint during ageing.
Surg Radiol Anat 27:51-55, 2005
Tsiklakis K, Syriopoulos K and Stamatakis HC: Radiographic
examination of the temporomandibular joint using
cone beam computed tomography. Dentomaxillofac
Radiol 33:196-201, 2004
Wiberg B, Wanman A: Signs of osteoarthrosis of the
temporomandibular joints in young patients. A clinical
and radiographic study. Oral Surg Oral Med Oral
Pathol 86:158-164, 1998
Widmalm SE, Kim J-K, Periera JF, Lundh H, Tasaki MM:
Temporomandibular joint pathosis related to sex, age
and dentition in autopsy material. Oral Surg Oral Med
oral Pathol. 78:416-425, 1994
Wiese M, Hintze H, Svensson P, Wenzel A: Comparison
of diagnostic accuracy of film and digital tomograms
for assessment of morphological changes in the TMJ.
Dentomaxillofac Radiol 36:12-17, 2007
Yamada K, Saito I, Hanada K, Hayashi T: Observation of
three cases of temporomandibular joint osteoarthritis
and mandibular morphology during adolescence using
helical CT. J Oral Rehabil 31:298-305, 2004a
Yamada K, Tsuruta A, Hanada K, Hayashi T: Morphology
of the articular eminence in temporomandibular joints
and condylar bone change. Journal of Oral Rehabil
31:438-44, 2004b
Δρούκας Β, Κεπεγιάννη Ο: Οι συστηματικές παθήσεις σε
σχέση με τις λειτουργικές διαταραχές του στοματο-
γναθικού συστήματος. Σύγχρονος Οδοντίατρος 5:87-
98, 1985
Δρούκας Β: Λειτουργία και δυσλειτουργία του στοματο-
γναθικού συστήματος. Εκδ. Παρισιάνου, σελ. 3-9, 299-
329, 1996
Ελευθεριάδης Ιωακείμ: Κλινική και ακτινογραφική εκτίμηση
των παθήσεων της κροταφογναθικής διάρθρωσης.
Εκδ. University Studio Press, Θεσσαλονίκη. σελ. 25-
33,74-141, 1990
Τμήμα Διαγνωστικής και Ακτινολογίας Στόματος, Οδοντιατρική Σχολή Πανεπιστημίου Αθηνών
(Διευθυντής: Καθηγητής Κ. Τσιχλάκης)
Αρχεία Ελληνικής Στοματικής και Γναθοπροσωπικής Χειρουργικής (2009) 2, 91-99
ΠΕΡΙΛΗΨΗ: Η Οδοντιατρική Υπολογιστική Τομογραφία είναι η μέθοδος εκλογής για την απεικόνι-
ση και αξιολόγηση των οστεοαρθριτικών αλλοιώσεων της κροταφογναθικής διάρθρωσης λόγω της
χαμηλής δόσης ακτινοβολίας που λαμβάνει ο ασθενής σε συνδυασμό με την πολύ υψηλής διαγνω-
στικής αξίας απεικόνιση της ΚΓΔ.
Σκοπός το άρθρου αυτού είναι η παρουσίαση περιστατικών ασθενών με σημεία και συμπτώματα
από τις ΚΓΔ, όπου ο απεικονιστικός έλεγχος με τον Οδοντιατρικό Υπολογιστικό Τομογράφο έπαι-
ξε καθοριστικό ρόλο στη διάγνωση οστεοαρθρίτιδας.
ΛΕΞΕΙΣ ΚΛΕΙΔΙΑ: Κροταφογναθική διάρθρωση, Οστεοαρθρίτιδα, Οδοντιατρικός υπολογιστικός
τομογράφος
REFERENCES
Alexiou KE, Stamatakis HC, Tsiklakis K: Evaluation of the
severity of Temporomandibular Joint osteoarthritic
changes related to age using Cone Beam CT.
Dentomaxillofac Radiol 38:141-147, 2009
Arai Y, Tammisalo E, Iwai K, Hashimoto K, Shinoda K:
Development of a compact computed tomographic
apparatus for dental use. Dentomaxillofac Radiol
28:245-248, 1999
Araki K, Maki K, Seki K, Sakamaki K, Harata Y, Sakaino R,
Okano T, Seo K: Characteristics of a newly developed
dentomaxillofacial X-ray cone beam CT scanner (CB
MercuRay): system configuration and physical
properties. Dentomaxillofac Radiol 33:51-59, 2004
Benson BW, Otis LL: Disorders of the temporomandibular
joint. Dent Clin North Am 38:167-185, 1994
Bertram S, Rudisch A, Innerhofer K, Pumpel E, Grubwieser
G Emshoff R: Diagnosing TMJ internal derangement
and osteoarthritis with magnetic resonance imaging.
Journal of American Dental Association 132:753-761,
2001
Brandlmaier I, Bertram S, Rudisch A, Bodner G, Emshoff R:
Temporomandibular joint osteoarthrosis diagnosed
with high resolution ultrasonography versus magnetic
resonance imaging: how reliable is high resolution
ultrasonography? J Oral Rehabil 30:812-817, 2003
Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG,
Omnell KA, Westesson PL, White SC: Imaging of the
temporomandibular joint: a position paper of the
American Academy of Oral and Maxillofacial Radiology.
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod. 83:609-618, 1997
Cholitgul W, Petersson A, Rohlin M, Tanimoto K,
Akerman S: Diagnostic outcome and observer performance
in sagittal tomography of the temporomandibular
joint. Dentomaxillofac Radiol 19:1-6, 1990
Cohnen M, Kemper J, Mobes O, Pawelzik J, Modder U:Radiation dose in dental radiology. Eur Radiol 12:634-
637, 2002
Delbalso A: Maxillofacial Imaging. W. B. Saunders Company,
1990, pp. 624-632.
Emshoff R, Brandimaier I, Bertram S, Rudisch A: Magnetic
resonance imaging findings of osteoarthrosis and effusion
in patients with unilateral temporomandibular
joint pain. Int J Oral Maxillofac Surg 31:568-602, 2002
Emshoff R, Rudisch A: Are internal derangement and osteoarthrosis
linked to changes in clinical outcome measures
of arthrocentisis of the temporomandibular
joint? J Oral and Maxillofac Surg 61:1162-1167, 2003
Gynther GW, Tronje G, Holmlund AB: Radiographic
changes in the temporomandibular joint in patients
with generalized osteoarthritis and rheumatoid
arthritis. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 81:613-618, 1996
Gynther GW, Tronje G: Comparison of arthroscopy and
radiography in patients with temporomandibular joint
symptoms and generalized arthritis. Dentomaxillofac
Radiol 27:107-112, 1998
Hansson LG, Hansson T, Petersson A: A comparison between
clinical and radiologic findings in 259 temporomandibular
joint patients. J Prosthet Dent 50:89-94,
1983
Holmund A, Hellsing G: Arthroscopy of the temporomandibular
joint. A comparative study of arthroscopic
and tomographic findings. Int J Oral Maxillofac Surg
128-133, 1988
Honda K, Larheim TA, Maruhashi K, Matzumoto K and
Iwai K: Osseous abnormalities of the mandibular condyle:
diagnostic reliability of cone beam computed
tomography compared with helical computed tomography
based on an autopsy material. Dentomaxillofac
Radiol 35:152-157, 2006
Ishibashi H, Takenoshita Y, Ishibashi K, Oka M: Agerelated
changes in the human mandibular condyle: a
morphologic, radiologic, and histologic study. J Oral
Maxillofac Surg 53:1016-1023, 1995
Kazuya H, Tore A.L, Johannessen S, Arai Y, Shinoda K,
Westesson P-L: Ortho cubic super-high resolution
computed tomography: A new radiographic technique
with application to the temporomandibular joint. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 91:239-
243, 2001
Lascala CA, Panella J, Marques MM: Analysis of the
accuracy of linear measurements obtained by cone
beam computed tomography (CBCT-NewTom).
Dentomaxillofac Radiol 33:291-294, 2004
Ludlow JB, Davies-Ludlow LE, Brooks SL: Dosimetry of
two extraoral direct digital imaging devices: NewTom
cone beam CT and Orthophos Plus DS panoramic
unit. Dentomaxillofac Radiol 32:229-234, 2003
Ludlow JB, Davies-Ludlow LE, Brooks SL, Howerton WB:
Dosimetry of 3 CBCT devices for oral and maxillofacial
radiology: CB MercuRay, NewTom 3G and i-
CAT. Dentomaxillofac Radiol 35:219-226, 2006
Mah J, Hatcher D: Three-dimentional craniofacial imaging.
Am J of Orthod Dentofacial Orthop 126:308-309,
2004
Mah JK, Danforth RA, Bumann A, Hatcher D: Radiation
absorbed in maxillofacial imaging with a new dental
computed tomography device. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 96:508-513, 2003
Martinez–Blanco M., Bagan JV, Fons A., Poveda – Roda R:
Osteoarthrosis of the temporomandibular joint. A
clinical and radiological study of 16 patients. Med Oral
9:106-115, 2004
Melchiorre D, Calderazzi A, Maddali Bongi S, Cristofani R,
Bazzichi L, Eligi C, Maresca M, Ciompi M: A comparison
of ultrasonography and magnetic resonance imaging
in the evaluation of temporomandibular joint
involvement in rheumatoid arthritis and psoriatic
arthritis. Rheumatology (Oxford) 42:673-676, 2003
Miles D, Van Dis M, Kaugars G, Lovas J: Oral & Maxillofacial
Radiology. Radiologic / Pathologic Correlations. W.B.
Saunders Company 1991, pp. 275-281
Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA: A
new volumetric CT machine for dental imaging based
on the cone-beam technique: preliminary results. Eur.
Radiol 8:1558-1564, 1998
Nilner M, Petersson A: Clinical and radiological findings
related to treatment outcome in patients with temporomandibular
disorders. Dentomaxillofac Radiol 24:
128-131, 1995
Roberts D, Pettigrew J, Udupa J, Ram C: Three-dimensional
imaging and display of the temporomandibular
joint. Oral Surg 58:461-474, 1984
Sukovic P: Cone beam computed tomography in craniofacial
imaging. Orthod. Craniofacial Res 6:31-36,
2003
Sulun T, Cemgil T, Duc JM, Rammelsberg P, Jager L,
Gernet W: Morphology of the mandibular fossa and
inclination of the articular eminence in patients with
internal derangement and in symptom-free volunteers.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
92:98-107, 2001
Toure G, Duboucher C, Vacher C: Anatomical modifications
of the temporomandibular joint during ageing.
Surg Radiol Anat 27:51-55, 2005
Tsiklakis K, Syriopoulos K and Stamatakis HC: Radiographic
examination of the temporomandibular joint using
cone beam computed tomography. Dentomaxillofac
Radiol 33:196-201, 2004
Wiberg B, Wanman A: Signs of osteoarthrosis of the
temporomandibular joints in young patients. A clinical
and radiographic study. Oral Surg Oral Med Oral
Pathol 86:158-164, 1998
Widmalm SE, Kim J-K, Periera JF, Lundh H, Tasaki MM:
Temporomandibular joint pathosis related to sex, age
and dentition in autopsy material. Oral Surg Oral Med
oral Pathol. 78:416-425, 1994
Wiese M, Hintze H, Svensson P, Wenzel A: Comparison
of diagnostic accuracy of film and digital tomograms
for assessment of morphological changes in the TMJ.
Dentomaxillofac Radiol 36:12-17, 2007
Yamada K, Saito I, Hanada K, Hayashi T: Observation of
three cases of temporomandibular joint osteoarthritis
and mandibular morphology during adolescence using
helical CT. J Oral Rehabil 31:298-305, 2004a
Yamada K, Tsuruta A, Hanada K, Hayashi T: Morphology
of the articular eminence in temporomandibular joints
and condylar bone change. Journal of Oral Rehabil
31:438-44, 2004b
Δρούκας Β, Κεπεγιάννη Ο: Οι συστηματικές παθήσεις σε
σχέση με τις λειτουργικές διαταραχές του στοματο-
γναθικού συστήματος. Σύγχρονος Οδοντίατρος 5:87-
98, 1985
Δρούκας Β: Λειτουργία και δυσλειτουργία του στοματο-
γναθικού συστήματος. Εκδ. Παρισιάνου, σελ. 3-9, 299-
329, 1996
Ελευθεριάδης Ιωακείμ: Κλινική και ακτινογραφική εκτίμηση
των παθήσεων της κροταφογναθικής διάρθρωσης.
Εκδ. University Studio Press, Θεσσαλονίκη. σελ. 25-
33,74-141, 1990
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