Skip to main content

Advertisement

SpringerLink
Log in

Introducing a novice-friendly classification system for magnetic resonance imaging of the temporomandibular joint disc morphology

  • Original Article
  • Published:
Oral Radiology Aims and scope Submit manuscript

A Correction to this article was published on 11 June 2022

This article has been updated

Abstract

Objective

To introduce a new classification, aiming to correspond TMJ disc configuration with diagnosis, meanwhile reduce difficulty and subjectivity in TMJ MRI evaluation and training of TMD diagnosis for dental students.

Methods

90 patients sought for TMD treatment were enrolled in the study, whose MRIs were used to establish the new classification. A total of 180 discs were evaluated using MRI for position (normal, DDWR or DDWoR) and classified by morphology according to previous (Murakami’s classification) and new classification respectively. 60 discs were selected and judged by two groups (2 TMJ specialists and 30 dental students) to assess the reliability and validity of the new classification. Questionnaires were acquired for all observers to assess the attitude toward two classification systems. Descriptive statistics, Spearman’s rank correlation coefficient, and intraclass correlation coefficient were performed. P < 0.05 was considered statistically significant.

Results

In the new classification, Class 1 disc was significantly correlated with DDWR and Class 3 disc was significantly correlated with DDWoR. Interobserver reliability/consistency for observers between TMJ specialists was 0.867 when Murakami’s classification was applied and 0.948 when the new classification was applied. Interobserver ICC value for dental students was 0.656 when using Murakami’s classification, and 0.831 when using the new classification. The difference in attitude toward different classification systems was statistically significant.

Conclusion

A new classification of TMJ disc configuration is presented. The correlation between disc morphology and position revealed helps diagnosis and management. The new classification improves TMJ MRI interpreting accuracy and provides a better learning and using experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Change history

References

  1. Westesson PL, Rohlin M. Internal derangement related to osteoarthrosis in temporomandibular joint autopsy specimens. Oral Surg Oral Med Oral Pathol. 1984;57(1):17–22.

    Article  Google Scholar 

  2. Arayasantiparb R, Tsuchimochi M, Mitrirattanakul S. Transformation of temporomandibular joint disc configuration in internal derangement patients using magnetic resonance imaging. Oral Sci Int. 2012;9:43–8.

    Article  Google Scholar 

  3. Vogl TJ, Lauer HC, Lehnert T, et al. The value of MRI in patients with temporomandibular joint dysfunction: correlation of MRI and clinical findings. Eur J Radiol. 2016;85(4):714–9.

    Article  Google Scholar 

  4. Yoshida H, Hirohata H, Onizawa K, et al. Flexure deformation of the temporomandibular joint disk in pseudodynamic magnetic resonance images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(1):104–11.

    Article  Google Scholar 

  5. Taşkaya-Yilmaz N, Oğütcen-Toller M. Magnetic resonance imaging evaluation of temporomandibular joint disc deformities in relation to type of disc displacement. J Oral Maxillofac Surg. 2001;59(8):860–5.

    Article  Google Scholar 

  6. Matsubara R, Yanagi Y, Oki K, et al. Assessment of MRI findings and clinical symptoms in patients with temporomandibular joint disorders. Dentomaxillofac Radiol. 2018;47(4):20170412.

    Article  Google Scholar 

  7. Pinto GNS, Grossmann E, Iwaki FL, et al. Correlation between joint effusion and morphology of the articular disc within the temporomandibular joint as viewed in the sagittal plane in patients with chronic disc displacement with reduction: a retrospective analytical study from magnetic resonance imaging. Cranio. 2021;39(2):119–24.

    Article  Google Scholar 

  8. Koh KJ, Park HN, Kim KA. Relationship between anterior disc displacement with/without reduction and effusion in temporomandibular disorder patients using magnetic resonance imaging. Imaging Sci Dent. 2013;43(4):245–51.

    Article  Google Scholar 

  9. Dias IM, Cordeiro PC, Devito KL, et al. Evaluation of temporomandibular joint disc displacement as a risk factor for osteoarthrosis. Int J Oral Maxillofac Surg. 2016;45(3):313–7.

    Article  Google Scholar 

  10. Roh HS, Kim W, Kim YK, et al. Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings. J Craniomaxillofac Surg. 2012;40(3):283–6.

    Article  Google Scholar 

  11. Rudisch A, Innerhofer K, Bertram S, et al. Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(5):566–71.

    Article  Google Scholar 

  12. Ottl P, Hohmann A, Piwowarczyk A, et al. Retrospective study on the evaluation of the TMJ by MRI using a newly developed standardized evaluation form. Cranio. 2008;26(1):33–43.

    Article  Google Scholar 

  13. Murakami S, Takahashi A, Nishiyama H, et al. Magnetic resonance evaluation of the temporomandibular joint disc position and configuration. Dentomaxillofac Radiol. 1993;22(4):205–7.

    Article  Google Scholar 

  14. Ottl P, Hohmann A, Piwowarczyk A, et al. Assessment of the temporomandibular joint using MRI and a new standardised evaluation form. Aktuelle Rheumatol. 2007;32(2):86–91.

    Article  Google Scholar 

  15. Schmitter M, Kress B, Hähnel S, et al. The effect of quality of temporomandibular joint MR images on interrater agreement. Dentomaxillofac Radiol. 2004;33(4):253–8.

    Article  Google Scholar 

  16. Widmalm SE, Brooks SL, Sano T, et al. Limitation of the diagnostic value of MR images for diagnosing temporomandibular joint disorders. Dentomaxillofac Radiol. 2006;35(5):334–8.

    Article  Google Scholar 

  17. Hirata FH, Guimarães AS, Oliveira JX, et al. Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI. Braz Oral Res. 2007;21(3):265–71.

    Article  Google Scholar 

  18. De Farias JF, Melo SL, Bento PM, et al. Correlation between temporomandibular joint morphology and disc displacement by MRI. Dentomaxillofac Radiol. 2015;44(7):20150023.

    Article  Google Scholar 

  19. Serindere G, Aktuna BC. MRI investigation of TMJ disc and articular eminence morphology in patients with disc displacement. J Stomatol Oral Maxillofac Surg. 2021;122(1):3–6.

    Article  Google Scholar 

  20. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group†. J Oral Fac Pain Headache. 2014;28(1):6–27.

    Article  Google Scholar 

  21. Kumar R, Pallagatti S, Sheikh S, et al. Correlation between clinical findings of temporomandibular disorders and MRI characteristics of disc displacement. Open Dent J. 2015;9:273–81.

    Article  Google Scholar 

  22. Orhan K, Nishiyama H, Tadashi S, et al. Comparison of altered signal intensity, position, and morphology of the TMJ disc in MR images corrected for variations in surface coil sensitivity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(4):515–22.

    Article  Google Scholar 

  23. Koca CG, Gümrükçü Z, Bilgir E. Does clinical findings correlate with magnetic resonance imaging (MRI) findings in patients with temporomandibular joint (TMJ) pain? A cross sectional study. Med Oral Patol Oral Cir Bucal. 2020;25(4):e495–501.

    Article  Google Scholar 

  24. Almăşan OC, Hedeşiu M, Băciuţ G, et al. Disk and joint morphology variations on coronal and sagittal MRI in temporomandibular joint disorders. Clin Oral Investig. 2013;17(4):1243–50.

    Article  Google Scholar 

  25. Emshoff R, Bertram A, Hupp L, et al. Condylar erosion is predictive of painful closed lock of the temporomandibular joint: a magnetic resonance imaging study. Head Face Med. 2021;17(1):40.

    Article  Google Scholar 

  26. Emshoff R, Bertram A, Hupp L, et al. A logistic analysis prediction model of TMJ condylar erosion in patients with TMJ arthralgia. BMC Oral Health. 2021;21(1):374.

    Article  Google Scholar 

  27. Hegab AF, Al Hameed HI, Karam KS. Classification of temporomandibular joint internal derangement based on magnetic resonance imaging and clinical findings of 435 patients contributing to a nonsurgical treatment protocol. Sci Rep. 2021;11(1):20917.

    Article  Google Scholar 

  28. Minston W, Benchimol D, Jacobs R, et al. Pre-surgical radiographic and clinical features as predictors for temporomandibular joint discectomy prognosis. Oral Dis. 2021. https://doi.org/10.1111/odi.13923.

    Article  Google Scholar 

  29. Hegab AF, Youssef AH, Hameed H, et al. MRI-based determination of occlusal splint thickness for temporomandibular joint disk derangement: a randomized controlled clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(1):74–87.

    Article  Google Scholar 

  30. Polat ME, Yanik S. Efficiency of arthrocentesis treatment for different temporomandibular joint disorders. Int J Oral Maxillofac Surg. 2020;49(5):621–7.

    Article  Google Scholar 

  31. Xiong X, Yin X, Liu F, et al. Magnetic resonance imaging-guided disc-condyle relationship adjustment via articulation: a technical note and case series. J Int Med Res. 2020;48(8):300060520951052.

    Article  Google Scholar 

Download references

Funding

This study was funded by Chengdu Science and technology Bureau (Grant/Award Number: 2019-YF05-00508-SN); Sichuan University (Grant/Award Number: 2018SCUH0082) and West China Hospital of Stomatology (Grant/Award Number: RD-03-202005).

Author information

Author notes

    Authors and Affiliations

    1. State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin South Road, Chengdu, 610041, China

      Qinlanhui Zhang, Yanji Gong, Fang Liu & Yang Liu

    2. State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China

      Qinlanhui Zhang & Xin Xiong

    Authors
    1. Qinlanhui Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Xin Xiong
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Yanji Gong
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Fang Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Yang Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Yang Liu.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

    Ethical approval

    All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institution Review Board of the West China Hospital of Stomatology, Sichuan University, China) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

    Informed consent

    Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for which identifying information is included in this article.

    Additional information

    Publisher's Note

    Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

    Qinlanhui Zhang and Xin Xiong contributed equally to this work

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhang, Q., Xiong, X., Gong, Y. et al. Introducing a novice-friendly classification system for magnetic resonance imaging of the temporomandibular joint disc morphology. Oral Radiol 39, 143–152 (2023). https://doi.org/10.1007/s11282-022-00615-0

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11282-022-00615-0

    Keywords

    Search

    Navigation