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Temporomandibular internal derangement: correlation of MRI findings with clinical symptoms of pain and joint sounds in patients with bruxing behaviour

¹ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey; ² Prosthodontist, Konya, Turkey; ³ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Selcuk University, Konya, Turkey; ⁴ Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey; ⁵ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey

*Correspondence to: Nurhan Güler, Yeditepe Üniversitesi Dihekimlii Fakültesi, Cerrahi AD Badat cad. No:238, Istanbul, Turkey; Email: nguler{at}dr.com

Received 21 January 2003; revised 2 July 2003; accepted 6 August 2003

Objectives: The aim of this study was to correlate magnetic resonance imaging (MRI) findings of effusion, disc displacement, condylar bony changes and disc form with clinical findings of pain and sounds in patients with bruxing and non-bruxing behaviour.

Methods: Disc displacement was confirmed by MRI in 102 joints from 64 patients (total of 128 joints) with bruxing behaviour who were referred for clinically diagnosed internal derangements of the temporomandibular joint (TMJ). Sixty joints with internal derangement from 30 patients without bruxing behaviour served as a control group. The clinical inclusion criteria were pain in the pre-auricular area and muscles of mastication, limitation or deviation in mandibular range of motion, and TMJ sounds. Signs of bruxism were diagnosed clinically and were obtained from the patient's history given on their first visit. Pain was evaluated using a visual analogue scale.

Results: Of the 102 joints in the study group with disc displacement, 53 (52%) showed disc displacement with reduction and 49 (48%) showed disc displacement without reduction. In the control group, 16 joints were classified as normal. Of the remaining 44 joints, 27 (61%) had disc displacement with reduction and 17 (39%) had unilateral disc displacement without reduction. Condylar bony changes were seen in 55% of the reducing joints in the study group and in 38% of the reducing joints in the control group, compared with 86% of the non-reducing joints in the study group and 24% of the non-reducing joints in the control group. There was a strong correlation between age and degenerative change in the study group. In the reducing joints, there was a significant difference in the prevalence of condylar bony changes between the study and control groups (P<0.01). In non-reducing joints, 30% of painful joints in the study group and 59% of those in the control group showed a strong signal in the joint space on T₂ weighted imaging. Statistically significant differences between the study and control groups were also found for disc form and the prevalence of effusion and disc displacement. Joint sounds were important in unilaterally affected joints in the study group. A statistically significant correlation was found between joint sounds and reducing joints (P<0.05).

Conclusion: It was demonstrated that a higher prevalence of condylar bony changes occurred in reducing joints in patients with bruxing behaviour.

Keywords: internal derangement; condylar bony changes; bruxism; parafunctional habits; MRI

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