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Evaluation of temporomandibular joint components and mandibular bone structure in ankylosing spondylitis patients

Published:August 26, 2022DOI:https://doi.org/10.1016/j.oooo.2022.08.009

      Objectives

      The study aimed to investigate the mandible and temporomandibular joint (TMJ) in patients with ankylosing spondylitis (AS) who had no signs or symptoms of TMJ-related disease and compare them with a control group.

      Study Design

      In total, 128 panoramic radiographs (63 patients with AS, 65 controls) were evaluated. Fractal analysis was conducted on the mandibular condyle (ROI1), angle of the mandible (ROI2), and the area adjacent to the mental foramen (ROI3). Articular eminence inclination (AEI) values were measured. Klemetti index (KI) evaluation of the mandibular cortex was also performed.

      Results

      Fractal dimension (FD) values were significantly lower in the patients with AS than the controls in ROI1 and ROI2 (P = .001), but there were no significant differences between groups for FD in ROI3, AEI, or KI (P ≥ .09). No significant differences were found in any parameters between patients with AS with different disease durations (P ≥ .06).

      Conclusions

      Patients with AS displayed significantly lower FD values in condyles and the angle of the mandible and slightly lower AEI values; therefore, they should be examined routinely for TMJ disorders. Clinicians should be aware of the possibility of secondary osteoporosis in patients with AS and consider its probable effects on the mandible.
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      References

        • Montala N
        • Juanola X
        • Collantes E
        • et al.
        Prevalence of vertebral fractures by semiautomated morphometry in patients with ankylosing spondylitis.
        J Rheumatol. 2011; 38: 893-897
        • Carter S
        • Lories RJ.
        Osteoporosis: a paradox in ankylosing spondylitis.
        Curr Osteoporos Rep. 2011; 9: 112-115
        • El Maghraoui A.
        Osteoporosis and ankylosing spondylitis.
        Joint Bone Spine. 2004; 71: 291-295
        • El Maghraoui A
        • Borderie D
        • Cherruau B
        • Edouard R
        • Dougados M
        • Roux C.
        Osteoporosis, body composition, and bone turnover in ankylosing spondylitis.
        J Rheumatol. 1999; 26: 2205-2209
        • Hanson C
        • Shagrin JW
        • Duncan H.
        Vertebral osteoporosis in ankylosing spondylitis.
        Clin Orthop Relat Res. 1971; 74: 59-64
        • Klingberg E
        • Lorentzon M
        • Göthlin J
        • et al.
        Bone microarchitecture in ankylosing spondylitis and the association with bone mineral density, fractures, and syndesmophytes.
        Arthritis Res Ther. 2013; 15: R179
        • Alman A
        • Johnson L
        • Calverley DC
        • Grunwald GK
        • Lezotte DC
        • Hokanson JE.
        Diagnostic capabilities of fractal dimension and mandibular cortical width to identify men and women with decreased bone mineral density.
        Osteoporos Int. 2012; 23: 1631-1636
        • Southard TE
        • Southard KA
        • Lee A.
        Alveolar process fractal dimension and postcranial bone density.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91: 486-491
        • Koh KJ
        • Park HN
        • Kim KA.
        Prediction of age-related osteoporosis using fractal analysis on panoramic radiographs.
        Imaging Sci Dent. 2012; 42: 231-235
        • Sánchez I
        • Uzcátegui G.
        Fractals in dentistry.
        J Dent. 2011; 39: 273-292
        • Rabelo KA
        • Sousa Melo LS
        • Torres MGG
        • Campos PSF
        • Bento PM
        • Melo DP.
        Condyle excursion angle, articular eminence inclination, and temporomandibular joint morphologic relations with disc displacement.
        J Oral Maxillofac Surg. 2017; 75 (938.e1-938.e10)
        • Unal Erzurumlu Z
        • Celenk P
        A radiological evaluation of the effects of edentulousness on the temporomandibular joint.
        J Oral Rehabil. 2020; 47: 319-324
        • Ren YF
        • Isberg A
        • Westesson PL.
        Steepness of the articular eminence in the temporomandibular joint: tomographic comparison between asymptomatic volunteers with normal disk position and patients with disk displacement.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 80: 258-266
        • Yamada K
        • Tsuruta A
        • Hanada K
        • Hayashi T.
        Morphology of the articular eminence in temporomandibular joints and condylar bone change.
        J Oral Rehabil. 2004; 31: 438-444
        • Locher M
        • Felder M
        • Sailer HF.
        Involvement of the temporomandibular joints in ankylosing spondylitis (Bechterew's disease).
        J Craniomaxillofac Surg. 1996; 24: 205-213
        • Huang -F
        • Chang CT
        • Muo CH
        • Chiu KM
        • Tsai CH
        • Liu SP.
        Bidirectional relationship between temporomandibular disorder and ankylosing spondylitis: a population-based cohort study.
        Clin Oral Investig. 2021; 25: 6377-6384
        • Ramos-Remus C
        • Major P
        • Gomez-Vargas A
        • et al.
        Temporomandibular joint osseous morphology in a consecutive sample of ankylosing spondylitis patients.
        Ann Rheum Dis. 1997; 56: 103-107
        • Nigil Haroon N
        • Szabo E
        • Raboud JM
        • et al.
        Alterations of bone mineral density, bone microarchitecture and strength in patients with ankylosing spondylitis: a cross-sectional study using high-resolution peripheral quantitative computerized tomography and finite element analysis.
        Arthritis Res Ther. 2015; 17: 377
        • Klemetti E
        • Kolmakow S.
        Morphology of the mandibular cortex on panoramic radiographs as an indicator of bone quality.
        Dentomaxillofac Radiol. 1997; 26: 22-25
        • Savic Pavicin I
        • Dumancic J
        • Jukic T
        • Badel T
        • Badanjak A.
        Digital orthopantomograms in osteoporosis detection: mandibular density and mandibular radiographic indices as skeletal BMD predictors.
        Dentomaxillofac Radiol. 2014; 4320130366
        • Klingberg E
        • Geijer M
        • Göthlin J
        • et al.
        Vertebral fractures in ankylosing spondylitis are associated with lower bone mineral density in both central and peripheral skeleton.
        J Rheumatol. 2012; 39: 1987-1995
        • White SC
        • Rudolph DJ.
        Alterations of the trabecular pattern of the jaws in patients with osteoporosis.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 628-635
        • Kato CN
        • Barra SG
        • Tavares NP
        • et al.
        Use of fractal analysis in dental images: a systematic review.
        Dentomaxillofac Radiol. 2020; 4920180457
        • Türkmenoğlu A
        • Yüksel HT
        • Karahan AY.
        Evaluation of mandibular condyle trabecular structure in patients with rheumatoid arthritis using fractal analysis.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2022; 133: 229-237
        • Major P
        • Ramos-Remus C
        • Suarez-Almazor ME
        • Hatcher D
        • Parfitt M
        • Russell AS.
        Magnetic resonance imaging and clinical assessment of temporomandibular joint pathology in ankylosing spondylitis.
        J Rheumatol. 1999; 26: 616-621
        • Helenius LM
        • Hallikainen D
        • Helenius I
        • et al.
        Clinical and radiographic findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control study.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99: 455-463
        • Gilboa I
        • Cardash HS
        • Kaffe I
        • Gross MD.
        Condylar guidance: correlation between articular morphology and panoramic radiographic images in dry human skulls.
        J Prosthet Dent. 2008; 99: 477-482
        • Helkimo M.
        Studies on function and dysfunction of the masticatory system. II. Index for anamnestic and clinical dysfunction and occlusal state.
        Sven Tandlak Tidskr. 1974; 67: 101-121
        • Koo TK
        • Li MY.
        A guideline for selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiro Med. 2016; 15: 155-163
        • Landis JR
        • Koch GG.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Seeman E
        • Delmas PD.
        Bone quality—the material and structural basis of bone strength and fragility.
        N Engl J Med. 2006; 354: 2250-2261
        • Lespessailles E
        • Roux J
        • Benhamou CL
        • et al.
        Fractal analysis of bone texture on os calcis radiographs compared with trabecular microarchitecture analyzed by histomorphometry.
        Calcif Tissue Int. 1998; 63: 121-125
        • Gratacós J
        • Collado A
        • Filella X
        • et al.
        Serum cytokines (IL-6, TNF-α, IL-1β and IFN-γ) in ankylosing spondylitis: a close correlation between serum IL-6 and disease activity and severity.
        Br J Rheumatol. 1994; 33: 927-931
        • Aydin T
        • Karacan İ
        • Demir SE
        • Sahin Z.
        Bone loss in males with ankylosing spondylitis: its relation to sex hormone levels.
        Clin Endocrinol. 2005; 63: 467-469
        • Obermayer-Pietsch BM
        • Lange U
        • Tauber G
        • et al.
        Vitamin D receptor initiation codon polymorphism, bone density and inflammatory activity of patients with ankylosing spondylitis.
        Osteoporos Int. 2003; 14: 995-1000
        • De Keyser F
        • Baeten D
        • Van den Bosch F
        • et al.
        Gut inflammation and spondyloarthropathies.
        Curr Rheumatol Rep. 2002; 4: 525-532
        • Pray C
        • Feroz NI
        Nigil Haroon N. Bone mineral density and fracture risk in ankylosing spondylitis: a meta-analysis.
        Calcif Tissue Int. 2017; 101: 182-192
        • Pantoja LLQ
        • Lustosa M
        • Yamaguti PM
        • et al.
        Pamidronate therapy increases trabecular bone complexity of mandibular condyles in individuals with osteogenesis imperfecta.
        Calcif Tissue Int. 2022; 110: 303-312
        • Aktuna Belgin C
        • Serindere G
        Fractal and radiomorphometric analysis of mandibular bone changes in patients undergoing intravenous corticosteroid therapy.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2020; 130: 110-115
        • Arsan B
        • Köse TE
        • Çene E
        • Özcan İ.
        Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2017; 123: 382-391
        • Kayipmaz S
        • Akçay S
        • Sezgin ÖS
        • Çandirli C.
        Trabecular structural changes in the mandibular condyle caused by degenerative osteoarthritis: a comparative study by cone-beam computed tomography imaging.
        Oral Radiol. 2019; 35: 51-58
        • Gumussoy I
        • Duman SB.
        Alternative cone-beam CT method for the analysis of mandibular condylar bone in patients with degenerative joint disease.
        Oral Radiol. 2020; 36: 177-182
        • Bertram F
        • Hupp L
        • Schnabl D
        • Rudisch A
        • Emshoff R.
        Association between missing posterior teeth and occurrence of temporomandibular joint condylar erosion: a cone beam computed tomography study.
        Int J Prosthodont. 2018; 31: 9-14
        • Bell WE.
        Clinical Management of Temporomandibular Disorders.
        Year Book Medical Publishers Chicago, Chicago, IL1982
        • Coşgunarslan A
        • Soydan Çabuk D
        • Canger EM.
        Effect of total edentulism on the internal bone structure of mandibular condyle: a preliminary study.
        Oral Radiol. 2021; 37: 268-275
        • İlgüy D
        • İlgüy M
        • Fişekçioğlu E
        • Dölekoğlu S
        • Ersan N.
        Articular eminence inclination, height, and condyle morphology on cone beam computed tomography.
        ScientificWorldJournal. 2014; 2014761714
        • Kavitha MS
        • Park SY
        • Heo MS
        • Chien SI.
        Distributional variations in the quantitative cortical and trabecular bone radiographic measurements of mandible, between male and female populations of Korea, and its utilization.
        PLoS One. 2016; 11e0167992
        • Magat G
        • Ozcan Sener S
        Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography.
        Oral Radiol. 2019; 35: 35-42