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Are morphologic and topographic alterations of the mandibular fossa after fixed functional treatment detectable on tomograms? Visual classification and morphometric analysis

Sind morphologische und topographische Veränderungen der Fossa mandibularis durch eine festsitzende funktionskieferorthopädische Apparatur auf Tomogrammen nachweisbar? Eine retrospektive visuelle Klassifikation und morphometrische Analyse

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Abstract

Aim

The goal was to evaluate if changes in morphology and topography of the mandibular fossa after Functional Mandibular Advancer (FMA) treatment are detectable on tomograms. Furthermore, the suitability of digital tomograms (DT) over magnetic resonance imaging (MRI) for this particular question was investigated.

Materials and methods

In all, 25 patients (14 female, 11 male) with a skeletal class II malocclusion received treatment with a FMA. DTs were available prior to (T1) and after (T2) FMA treatment. A total of 50 temporomandibular joints were investigated. The mandibular fossae were evaluated metrically and visually regarding treatment-induced alterations. A p < 0.05 was set as the level for statistical significance for all tests. Results were compared to the results of a recent MRI study.

Results

Visual inspection of all 50 joints in the DT at T1 and T2 revealed no alterations of the fossa shape in the sagittal plane; 24 patients showed identical morphology of right and left joints. The metrical analysis revealed no significant changes regarding width, depth and ratio thereof between T1 and T2. There also were no bilateral differences. Another 18 different distance measurements between porion, mandibular fossa, articular eminence and pterygoid fossa showed no significant changes. There was no detectable proof of a fossa shift.

Conclusions

No changes in the sagittal plane, mandibular fossa, the articular tubercle, or a possible fossa shift were found in the DT of class II patients after FMA treatment. DT and MRI measurements and the visual inspection revealed identical findings; thus, DT appears to be a valuable research tool for sagittal analysis of mandibular fossa changes.

Zusammenfassung

Zielsetzung

Ziel der Studie war es zu überprüfen, ob potenzielle Effekte einer Behandlung mit einem FMA („functional mandibular advancer“) auf Morphologie und Topographie der Fossa mandibularis an digitalen Tomogrammen darstellbar sind. Ihre Eignung als diagnostisches Mittel wurde im Vergleich mit der MRT (Magnetresonanztomographie) untersucht.

Material und Methoden

Fünfundzwanzig Patienten (14 weiblich, 11 männlich) mit skelettaler Klasse-II-Malokklusion wurden mit dem FMA behandelt. Tomogramme waren für den Zeitpunkt vor (T1) und nach (T2) der FMA-Behandlung verfügbar. Insgesamt wurden 100 Kiefergelenke (KGs) untersucht. Die Fossae mandibulares wurden metrisch und visuell auf mögliche therapeutisch induzierte Veränderungen hin evaluiert. Bei allen statistischen Tests wurde Signifikanz bei p < 0,05 angenommen. Die Ergebnisse der Tomogrammstudie wurden mit denen einer MRT-Studie verglichen.

Ergebnisse

Die visuelle Befundung der Tomogramme zu den beiden definierten Kontrollzeitpunkten ergab bei allen 50 Kiefergelenken keine Veränderungen der Fossaform in der Sagittalebene. Zudem war bei 24 Patienten die Morphologie der Fossae bei rechtem und linkem Gelenk identisch. Die metrische Analyse zeigte keine signifikanten Veränderungen hinsichtlich Breite, Tiefe und deren Verhältnis zueinander zu den beiden definierten Kontrollzeitpunkten, auch nicht im Seitenvergleich. Weitere 18 Streckenmessungen zwischen Porion, Fossa mandibularis, Tuberculum articulare und Fossa pterygoidea ergaben bei allen 50 Gelenken weder insgesamt noch unterteilt in rechte und linke Seite noch im Seitenvergleich signifikante Veränderungen. Hinweise auf einen Fossa „shift“ gibt es nicht.

Schlussfolgerungen

Bei der Behandlung mit einer starren, festsitzenden, funktionskieferorthopädischen Apparatur zur Korrektur von Distalbisslagen ergaben weder die visuelle Befundung noch verschiedene metrische Analysen an sagittalen Tomogrammen Hinweise auf morphologische Veränderungen der Fossa mandibularis und des Tuberculum articulare sowie auf einen möglichen Fossa „shift“. Da die Absolutwerte identischer Messungen an den Tomogrammen und den MRT-Aufnahmen beim selben Kollektiv vergleichbar sind und auch die visuellen Befundungen einander entsprechen, stellt in der Sagittalebene das Tomogramm eine diagnostische Alternative zur MRT dar.

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Authors and Affiliations

  1. Department of Orthodontics, Saarland University, Universitätskliniken 56, 66421, Homburg/Saar, Germany

    Gero Stefan Michael Kinzinger,  Jörg Alexander Lisson, Dania Booth & Jan Hourfar

  2. Private Orthodontic Practice, Toenisvorst, Germany

    Gero Stefan Michael Kinzinger

  3. Private Orthodontic Practice, Rheinberg, Germany

    Dania Booth

  4. Private Orthodontic Practice, Michelstadt, Germany

    Jan Hourfar

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  1. Gero Stefan Michael Kinzinger
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  2. Jörg Alexander Lisson
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  3. Dania Booth
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Correspondence to Jörg Alexander Lisson.

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Conflict of interest

G.S.M. Kinzinger, J.A. Lisson, D. Booth and J. Hourfar declare that they have no competing interests.

Ethical standards

Ethical approval for this retrospective study was obtained from the Institutional Review Board (IRB). For this type of study formal consent is not required.

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Kinzinger, G.S.M., Lisson, J.A., Booth, D. et al. Are morphologic and topographic alterations of the mandibular fossa after fixed functional treatment detectable on tomograms? Visual classification and morphometric analysis. J Orofac Orthop 79, 427–439 (2018). https://doi.org/10.1007/s00056-018-0156-y

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