Comparison of bony changes between panoramic radiograph and cone beam computed tomographic images in patients with temporomandibular joint disorders

Dong-Yul Lee; Yun-Jung Kim; Yun-Heon Song; Nam-Ho Lee; Yong-Kyu Lim; Sung-Taek Kang; Sug-Joon Ahn

doi:10.4041/kjod.2010.40.6.364

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Lee, Kim, Song, Lee, Lim, Kang, and Ahn: Comparison of bony changes between panoramic radiograph and cone beam computed tomographic images in patients with temporomandibular joint disorders

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2010; 40(6): 364-372.

Published online: 31 December 2010

DOI: https://doi.org/10.4041/kjod.2010.40.6.364

Comparison of bony changes between panoramic radiograph and cone beam computed tomographic images in patients with temporomandibular joint disorders

Dong-Yul Lee, DDS, MSD, PhD^a, Yun-Jung Kim, DDS, MDS, PhD^b, Yun-Heon Song, DDS, MDS, PhD^b, Nam-Ho Lee, DDS, MSD^c, Yong-Kyu Lim, DDS, MSD, PhD^a, Sung-Taek Kang, DDS, MSD^d, Sug-Joon Ahn, DDS, MSD, PhD^e

^aProfessor, Department of Orthodontics, Graduate School of Clinical Dentistry, Korea University, Korea.

^bPrivate Practice.

^cGraduate Student, Department of Orthodontics, Graduate School of Clinical Dentistry, Korea University, Korea.

^dClinical Instructor, Department of Orthodontics, Graduate School of Clinical Dentistry, Korea University, Korea.

^eAssociate Professor, Department of Orthodontics, School of Dentistry, Seoul National University, Korea.

Corresponding author: Sug-Joon Ahn. Department of Orthodontics, School of Dentistry, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-768, Korea. +82 2 2072 2672; titoo@snu.ac.kr.

Received 27 April 2010 Revised 8 August 2010 Accepted 11 August 2010

Abstract

Objective

This study was designed to assess the diagnostic validity of digital panoramic radiographs compared to cone beam computed tomography (CBCT) in patients with temporomandibular joint disorders.

Methods

Panoramic radiograph and CBCT were taken from a total of 212 joints from 106 subjects. The joints were examined by two dentists and divided into the following six groups: normal, flattening, osteophyte formation, erosion, sclerosis, and unclassified. The sensitivity and specificity of each observer and inter-observer reliability were statistically analyzed.

Results

The results showed relatively high intra-observer reliability in the diagnosis of both panoramic and CBCT images and the weighted Kappa indices of panoramic and CBCT images were 0.714 and 0.727, respectively. The sensitivities of panoramic images of observer A and B to CBCT images was 82.35% and 84.30%, respectively, while the specificity of observer A and B was 58.06% and 61.54%, respectively. However, guided diagnosis from panoramic and CBCT images were statistically different (p < 0.05).

Conclusions

The present study suggests that the panoramic radiograph could be used as a primary diagnostic device to detect bony changes of temporomandibular joints in clinical orthodontics, because panoramic images showed relatively high sensitivity compared to CBCT images. However, CBCT images may be one of the best choices when a more accurate diagnosis is necessary.

Keywords: Temporomandibular joint, Bony change, CBCT, Panoramic radiograph

Figures and Tables

Fig. 1

Different type of condylar shapes in cone beam computed tomography sagittal imaging (A, Normal; B, flattening; C, sclerosis; D, osteophyte; E, erosion).

Table 1

Distribution of gender and age in this study

Table 2

Comparison of diagnoses of temporomandibular joint disorders between observers A and B

^*Type of condyle that has multiple bony changes at the same time.

Table 3

Detailed diagnoses of complex groups between observer A and B

F, Flattening; O, osteophyte; E, erosion; S, sclerosis; U, unclassified.

Table 4

Diagnosis rates of abnormality of mandibular condyle according to observers

Table 5

Diagnosis agreement rates of abnormality of mandibular condyle between panorama and CBCT images

Table 6

Statistical values regarding diagnostic agreement of observers

^*p < 0.05.

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