Condylar Remodeling in Temporomandibular Disorder Using 3D Surface Models

OBJECTIVES: To assess 3D condylar morphology and evaluate condylar remodeling in patients with history temporomandibular disorder (TMD) using Cone-Beam CT (CBCT) images.

METHODS: This cross-sectional study constructed 3D virtual models of the mandible from CBCT images of 20 patients with TMD symptoms. All subjects were referred for radiological assessment of their TMJ morphology. Construction of 3D surface models utilized semi-automatic publicly available image analysis software.

RESULTS: Three-dimensional virtual surface models allowed clear visualization of 3D shape as well as surface erosions, osteophytes and surface flattening. Nineteen subjects showed either flattening and/or osteoarthritic changes. Condylar flattening was observed in 60% of the subjects and osteoarthritic changes were found in 95% of the cases. Osteoarthritic changes varied from surface irregularities to erosions (present in 40% of the right and left condyles). Different degrees for surface remodeling were observed and varied from partial surface to whole condylar head remodeling (5 out of 40 right and left condyles). Condyles with incipient surface remodeling displayed a characteristic morphology with the long axis of the condyle forming an unusually large angle to the trans-meatal line.

CONCLUSIONS: 3D virtual surface models can aid diagnosis of even small bone remodeling changes. This pilot study reveals that condylar remodeling was a common finding, and that condylar morphology might be a factor indicative of the onset of pathological remodeling in TMD patients.

Supported by NIDCR DE017727.