The Study On The Prevalence And Related Factors Of Temporomandibular Joint Osteoarthropathy In Orthodontic Patients

Objective: To investigate the prevalence of patients suffering from the temporomandibular joints(TMJOA),to analyze the relationship between age,sex,skeletal pattern and TMJ,and to evaluate the relationship between clinical signs and cone beam computed tomography(CBCT))imaging signs.TMJOA related factors are selected to provide reference for clinical diagnosis and treatment.Methods: Patients of 835 with CBCT images and clinical examination at Orthodontic Department of the Stomatology Hospital affiliated to China Medical University were selected between January 2016 and December 2020.The participants were classified into adolescents(10 to 18 years)and adult(19-55 years old)groups,and each group involved608 cases and 227 cases,respectively.ICAT Vision software was used to rebuild and record CBCT data of imaging signs: ill-defined cortical bone(type Ⅰ);erosive defect(type Ⅱ);bone proliferation(type Ⅲ);generalized sclerosis(type Ⅳ);short condylar or form change(type Ⅴ);subcortical cyst(type Ⅵ).Clinical symptoms include clicking,range and deviation of mouth opening,and joint or muscle pain.The prevalence of TMJOA was investigated by CBCT and clinical examination among patients before orthodontic treatment.The prevalence of TMJOA and related age was calculated in using SPSS25.0 software.By using chi-square,the relationship between prevalence of TMJOA and gender can be analyzed.TMJOA in different sagittal skeletal pattern and vertical skeletal pattern were counted.TMJOA associated with the risk factors was analyzed by using logistic regression analysis.The composition ratio of clinical and imaging signs of TMJOA patients were calculated,and the association between TMJOA patients with clinical signs and their corresponding imaging signs was analyzed by Spearman rank correlation.Results: 1.The occurrence of TMJOA were 31.27%(71/227)and 22.36%(136/608)in adult and adolescent groups,respectively.2.The occurrence of TMJOA increased with age in all gender and age groups.There were significant differences between the female age and age(P < 0.05).3.The occurrence of TMJOA in females was higher than that in males in both groups,and the difference was statistically significant(P < 0.05).Among adults,the occurrence of TMJOA in females was 35.62%(57/160),which was higher than that in male 20.89%(14/67);Adolescent group: the occurrence of TMJOA in female was 25.73%(106/412)higher than the male 15.31%(30/196).4.The sagittal skeletal pattern: the occurrence of TMJOA in skeletal class Ⅱ(48.51%)was highest among adults groups,with the females(55.56%)higher than males(31.03%),and the adult group(48.51%)higher than the adolescents group(28.57%).Vertical skeletal pattern: the occurrence of TMJOA in high angle(57.14%)was the highest in the adult group,among which the female group(60.46%)was higher than the male group(46.15%),and the adult group(57.14%)was higher than the adolescents group(33.14%).5.The high risk factors of TMJOA were skeletal class Ⅱ and high angle in adults.The risk factors of TMJOA are age,gender,skeletal class Ⅱ and high angle in adolescents groups.6.In the imaging manifestations of bone proliferation(type Ⅲ,33.33%)and condylar short,bone proliferation(type Ⅴ,31.31%),high detection rate,ill-defined cortical bone(type Ⅰ,44.31%)and erosive defect(type Ⅱ,23.35%)were higher.Among 207 TMJOA cases,105(50.72%)had clinical signs,and clanging was the highest(67.62%,71/105).7.Among adult and adolescent TMJOA patients,TMJOA patients with clinical signs showed significant correlation with cone-beam CT imaging signs.Conclusion: TMJOA patients are not rare in the initial diagnosis of orthodontics.The occurrence of TMJOA were 31.27%(71/227)and 22.36%(136/608)in adult and adolescent groups,respectively.After fully understanding of the situation of the temporomandibular joint,orthodontists should early diagnose the patients with the characteristics of risk factors such as age,female,skeletal classes Ⅱ and high angle,and reduce the adverse effect on growth of teeth and jaw,as well as avoid aggravating TMJOA.The development of TMJOA was based on the clinical manifestations of patients.However,not all the patients had clinical signs,which implies that orthodontists should be more cautious about potential at-risk patients.