CBCT Evaluation of the effects of loss of posterior teeth on the mandibular condyle

CBCT Evaluation of the effects of loss of posterior teeth on the mandibular condyle

1. Special Thanks to Prof. Dr. Ahmed Yehia Ashour B.D.S, M.S, Ph.D. Dean of Faculty of Dentistry P.U.A Professor of Restorative Dentistry

2. Special Thanks to Prof. Dr. Fayza Mahmoud El-Daly B.D.S, Ph.D. Vice Dean of Faculty of Dentistry P.U.A

3. Great Thanks to Prof. Dr. Magda Mohamed Saleh B.D.S, Ph.D. Head of DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

4. Particular Appreciation to Dr. Haitham Sakr L ecturer At PUA

5. Presented By Abdullah Mohamed Abd- ElRahman Hassan Gouda Atia Ahmed Shamseldin

6. Welcome

7. CBCT evaluation of the effects of loss of posterior teeth on the mandibular condyle

8. Introduction TMJ Condyle CBCT AIM of study Patients and methods Patient selection Methods Used Statistical analysis Results What we observed Tables Conclusion And recommendation References

9. Introduction TMJ & Condyle The Teeth CBCT

10. TMJ The functions of the temporomandibular joint, is to provide smooth, efficient movement of the mandible during mastication, swallowing and speech and to provide stability of mandibular position and prevent dislocation from external or unusual forces. The temporomandibular joint is a unique joint that can be affected by different kinds of hard and soft tissue abnormalities. The bony components of TMJ need a careful study since the changes in these components may imply functional disorders and pain. Temporomandibular joint disorders are a subdivision of musculoskeletal pathologies which act as a source of orofacial pain of non dental origin . These temporomandibular joint disorders are frequently associated with certain degenerative bony changes that include; Flattening, Erosion, Osteophytes etc , all of which involve the bony components of TMJ. Condyle The  mandible  is composed of the body, the ramus and condyle at the most superior part and is located inferior to the maxilla. they join the body at the angle of the  mandible. The mandibular condyle (or head), besides joint function, acts as a site of regional adaptive growth even under functional load supported by its cartilage.  Mandibular condyle morphology is characterized by a rounded bone projection with an upper biconvex and oval surface in axial plane. The condyle presents an articular surface for articulation with the  articular disk  of the  temporomandibular joint . The condyle is a very special part of the TMJ, It expresses the center of mandibular growth.

11. Teeth Teeth are the main functional component of the oral cavity. Teeth provide a variety of function including mastication, speech and esthetics . Tooth loss occurs in the oral cavity by various causes such as dental caries, periodontal diseases, trauma, pulpal and periapical diseases and various systemic diseases. The teeth provide a stable vertical and horizontal relation of mandible to maxilla and provide guiding planes for movement of the mandible anteriorly and laterally in the range of the mandibular movement during which the teeth are in contact. Loss of posterior teeth followed by loss of occlusal curve may tip the balance from adaptation with functional harmony towards disordered function . The absence of posterior teeth has been described as an etiological factor of high prevalence in the functional alterations of the stomatognathic system

12. CBCT Cone-beam computed tomography systems (CBCT) are a variation of traditional  computed tomography (CT)  systems. The CBCT systems used by dental professionals rotate around the patient, capturing data using a cone-shaped X-ray beam. These data are used to reconstruct a three-dimensional (3D) image of the following regions of the patient’s anatomy: dental (teeth); oral and maxillofacial region (mouth, jaw, and neck); and ears, nose, and throat X-ray imaging, including dental CBCT, provides a fast, non-invasive way of answering a number of clinical questions. Dental CBCT images provide three-dimensional (3-D) information, rather than the two-dimensional (2-D) information provided by a conventional X-ray image. This may help with the diagnosis, treatment planning and evaluation of certain conditions. .

13. The present study was designed to investigate the effect of bilateral loss of mandibular posterior teeth on the mandibular condyle dimensions and volume using CBCT. Aim of study

14. Introduction TMJ Condyle CBCT AIM of study Patients and methods Patient selection Methods Used Statistical analysis

15. Patient Selection This study was performed on 23 patients. Age Range 30-60 Years. 13 10 Kennedy Class I Patients Fully Dentate Patients All CBCTS were taken in Pharos University Radiology Center The study was approved by the Faculty’s research ethics committee .. The control group had a complete set of teeth The study group had bilateral loss of mandibular teeth (all lower molars and second premolar at least) All patients were Class I skeletal pattern, This was determined by measuring the ANB angle. No. of Cases Exclusion criteria Persons below 18 years of age, P atients with Temporo-mandibular Diseases, patients with maxillofacial trauma and history of condylar fracture, P atients with degenerative bone diseases, P atient with oral malignancy, P atients with severe malocclusion, P atients with a history of orthodontic treatment having with skeletal deformity, A nd persons whose radiographs do not reveal the condylar anatomy clearly were excluded from the study group.

16. Methods Used CBCT scans were performed with Soredex SCANORA 3D Exposure was done at 120 kV and 26.9 s acquisition time. The voxel dimension selected was 0.2 mm . The image detector was a flat panel measuring 20 × 25 cm, and images were acquired at 14 bit in a single 360 ° rotation The field of view was adjusted to cover the condyles bilaterally . On the multiplanar (MPR) screen, coronal and sagittal views were reoriented to view the widest condyle dimension in each plane. CBCT scan data were saved as DICOM files (Digital imaging and communications in medicine) then transferred to another workstation to view the images using BlueSky 3D Plan software & ANATOMAGE Invivo software. Condyle mediolateral width was measured on the corrected coronal view on the axial plane passing through the widest condyle dimension using the linear measurement tool on the software Condyle antero-posterior dimension was measured on the corrected sagittal view on a line connecting the most prominent anterior (A) and posterior (P) points of the condylar head. CBCT Microsoft Office Excel was used for data handling and graphical presentation. All data were collected, tabulated and subjected to statistical analysis. Statistical analysis was performed with IBM® SPSS® Statistics Version 25 for Windows. All variables were described by the mean, standard deviation (SD). Data were explored for normality by checking the distribution of data and using Kolmogorov–Smirnov test of normality. Significance level was considered at P<0.05 .

17. Introduction TMJ Condyle CBCT AIM of study Patients and methods Patient selection Methods Used Statistical analysis Results What we observed Tables

18. Results All parameters were assessed separately on right and left TMJs of the study and control groups. Kennedy class I patients showed statistically significant higher mean condyle width than control group. No statistically significant difference was found between the study group and the control group regarding condyle Antero-Posterior dimension. Observations and Tables Width of Condyle In Normal Patients ( Sagittal View ) Right Coronal and Sagittal View in a patient 1 of Control Group Left Coronal and Sagittal View in a patient 1 of Control Group Right Coronal and Sagittal View in a patient 2 of Control Group Left Coronal and Sagittal View in a patient 2 of Control Group Width of Condyle In Normal Patients ( Coronal View ) Right Left Study group Patient 1 ( coronal and sagittal view ) Right Left Study group Patient 2 ( coronal and sagittal view ) Right Left Right Left Left Condyle width of sagittal View ( Study Group ) Condyle width of Coronal View ( Study Group )

19. Introduction TMJ Condyle CBCT AIM of study Patients and methods Patient selection Methods Used Statistical analysis Results What we observed Tables Conclusion And Recommendation

20. Conclusion Loss of posterior teeth is accompanied by significant decrease in condyle height and increase in condyle width with no change in the total condyle volume or antero-posterior dimensions. Condyle mediolateral width in the study group showed 18.52 mean and 2.06 standard deviation while the control group showed 17.21 mean and 2.39 SD. The P value was lower than 0.05 so that condyle mediolateral width was significantly higher in the study group than the control group. Condyle antero-posterior dimension in the study group showed lower mean in the study group (8.27) than the control group (8.43) but the P value was higher than 0.05 so that there was no significant change in condyle antero-posterior dimension.

21. Further investigations has to be done in this matter, with more advanced scanning and measurement systems Recommendation

22. Thank You!