Ignorance: the only thing more expensive than education.
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Attitude of Health Personnel↗
Biomedical subjects
S L Brooks
Publications and source records attributed to S L Brooks.
Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status.
OBJECTIVE: The purpose of this study was to investigate interobserver reliability of a new technique for quantification of magnetic resonance images of temporomandibular joint disk status. STUDY DESIGN: Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for analysis. Four experienced observers traced the articular disk and osseous structures on sagittal magnetic resonance slice images. Quantitative measurements of disk length and disk displacement were recorded for each slice of 57 joints traced by each observer through use of a new quantification technique. Intraclass correlation coefficients were computed to assess interobserver agreement in the tracing of joint structures. RESULTS: The calculated intraclass correlation coefficient was 0.681 for disk length and 0.830 for disk displacement. In addition, the mean variability among observers was 1.041 mm for measurement of disk length and 0.972 mm for measurement of disk displacement. CONCLUSIONS: Interobserver agreement is high when the new quantification technique is used to interpret magnetic resonance images.
Adolescent↗
A celebration of the "impossible".
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Diagnosis, Oral↗
A longitudinal study of idiopathic osteosclerosis and condensing osteitis.
OBJECTIVE: To document the prevalence of idiopathic osteosclerosis (IO) and condensing osteitis (CO) in a middle-age-to-older adult population and determine their long term behavior. STUDY DESIGN: Full-mouth radiographs of 1585 adults, with a mean age 44.0 years, were evaluated for the presence of radiopaque masses diagnosed as IO or CO. All lesions were followed for 2 to 28 years, mean 10.4, to determine changes in size and shape. RESULTS: There were 187 lesions detected, 100 IO in 90 subjects (5.7%) and 87 CO in 71 subjects (4.5%). At follow-up, 180 lesions (96%) were still present, of which 155 were unchanged in size, 18 were smaller, and 7 were larger. CONCLUSIONS: Idiopathic osteosclerosis in middle age to older adults is stable and requires no further action after documentation in the patient's clinical records.
Adult↗
Guidelines for radiologic examinations: do we have all the answers yet?
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Guidelines as Topic↗
Imaging of the temporomandibular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology.
Various imaging techniques for the temporomandibular joint are discussed with respect to uses, strengths, and limitations. An imaging protocol is outlined for evaluating patients with a wide variety of temporomandibular joint related signs and symptoms.
Arthrography↗
Usefulness of tomography in the evaluation of patients with temporomandibular disorders: a retrospective clinical study.
OBJECTIVES: To evaluate the effect of temporomandibular joint tomography on the diagnosis and management of temporomandibular disorders and to determine whether there were any clinical predictors of usefulness of tomography in providing new information helpful in the treatment of these patients. STUDY DESIGN: The charts of 116 patients with temporomandibular joint tomograms were reviewed retrospectively for presenting signs and symptoms, initial clinical diagnosis, and alterations in diagnosis and management as a result of tomography. RESULTS: Common clinical diagnoses included osteoarthrosis (54%) and internal derangement (42%). Tomography changed the diagnosis in 24%, mainly adding or subtracting osteoarthrosis, and altered the management in 17%. Most of the latter were minor changes in treatment recommendations. There were few clinical variables that were related to whether tomography changed diagnosis or management. CONCLUSIONS: Tomography seems to have a minimal effect on the diagnosis or management of temporomandibular disorders based on the results of this retrospective study.
Adolescent↗
Frequency of radiopaque turbinate bones on lateral cephalometric radiographs.
The lateral cephalometric radiograph of an orthodontic patient demonstrated a large round radiopaque mass resembling an osteoma in the posterior maxillary sinus. Determination that this mass was simply a prominent inferior turbinate bone prompted this study to determine the frequency of visible turbinates on cephalometric radiographs. After calibration, one observer evaluated 479 pretreatment lateral cephalometric radiographs from an orthodontic/orthognathic surgery patient pool for radiopaque inferior turbinates. Ten percent of the films were reevaluated to assess intraexaminer reliability. The sample had a mean age of 23 years, range of 5 to 69 years, with a male/female ratio of 1:15. Visible inferior turbinates were observed on 76.8% of the radiographs. The frequency of visible turbinates was independent of gender, age, and film density. Clinicians should be aware of the frequency of this anatomic finding, so that patients are not subjected to unnecessary diagnostic tests.
Adolescent↗
Gradient-echo MR imaging of the temporomandibular joint: diagnostic pitfall caused by the superficial temporal artery.
OBJECTIVE: In routine MR imaging of the temporomandibular joints, a low-signal structure posterosuperior to the mandibular condyle is occasionally seen on the two-dimensional gradient-echo sequence. The structure is ovoid and may have a higher-signal core, simulating a loose body within the joint. We undertook a clinical and cadaveric study to determine the cause of this finding. MATERIALS AND METHODS: In a clinical study, we reviewed the MR images of 100 temporomandibular joints. We scored each joint for the presence and appearance of a low-signal structure posterosuperior to the mandibular condyle: type 1 was ovoid with a low-signal rim and a higher-signal core, type 2 was ovoid with uniformly low signal, type 3 was a low-signal structure inseparable from the posterior wall of the glenoid fossa, and type 4 was normal. Using this scoring system, we determined the appearance and frequency of the finding on two-dimensional gradient-echo, T1-, T2-, and proton density-weighted images. To determine the cause of the finding, we correlated the imaging and anatomic findings in a cadaveric specimen. RESULTS: Of the 100 MR images of joints reviewed, 22 showed a type 1 structure, 24 a type 2 structure, 11 a type 3 structure, and 43 were normal. The finding was seen only on the two-dimensional gradient-echo sequences, never on the spin-echo sequences. Correlation between the imaging and anatomic findings in the cadaveric specimen showed that the finding was caused by the superficial temporal artery. The variability in its appearance is thought to result from the complex manifestations of flowing blood within this artery. CONCLUSION: The finding posterosuperior to the mandibular condyle seen on two-dimensional gradient-echo MR images is a flow phenomenon within the superficial temporal artery. Recognition of the nature of this finding will avoid mistaking it for disease, such as an intraarticular loose body.
Adult↗
Validation of a specific selection criterion for dental periapical radiography.
It has been recommended that the prescription of dental radiographic examinations be based on a series of selection criteria. This study evaluated the usefulness of the presence of a large or deep restoration as an indicator for the need for a radiographic examination. Patients in need of routine examinations were questioned regarding pain in restored teeth. The radiographs of 2269 restored teeth in 209 patients were evaluated for depth of restoration and presence or absence of periapical pathosis. Another 1306 nonrestored teeth in 100 patients were evaluated similarly. There was an association between pain and periapical pathosis and between depth of restoration and periapical pathosis (p < 0.001 in each case). Radiographic yield for positive apical findings was low in restored teeth, especially when the restoration was shallow. The radiographic yield may be increased if other factors such as pain or integrity of the restoration are used to help make the decision regarding the need for radiographs.
Chi-Square Distribution↗
Temporomandibular joint: value of coronal MR images.
To evaluate the use of coronal magnetic resonance (MR) imaging in assessment of disk position in the temporomandibular joint (TMJ), sagittal and coronal 1.5-T MR images were obtained of 158 TMJs in 79 patients. From the sagittal images, medial or lateral displacement was suspected in 24 joints. Displacement could be confirmed from coronal images in 21 joints but could not be confirmed in three. In 18 other joints, the coronal images revealed a lateral or medial displacement that was not evident on sagittal images. In seven of these 18, displacement was purely lateral or purely medial, whereas the other 11 had a combination of anterior and lateral or medial displacement. On the basis of only sagittal images, the seven with pure displacement would have been diagnosed as normal. Use of the coronal plane added diagnostic information to that obtained with sagittal imaging and may increase diagnostic accuracy. Coronal images are therefore recommended as a supplement to sagittal images in MR imaging evaluation of the TMJ.
Adolescent↗
Computed tomography.
Although CT scanning has been available for less than 20 years, it has made a major impact on the practice of dentistry, particularly in oral and maxillofacial surgery, in the diagnosis and management of a wide variety of oral lesions. The use of computers to reconstruct x-ray attenuation data into an image allows the clinician to view pathology from many different perspectives, unobstructed by other anatomic structures, and to adjust contrast to concentrate on the soft-tissue and hard-tissue pathology in turn. Advances in computer software already allow three-dimensional visualization of pathology and anatomy, but additional refinements in this technology still are expected.
Humans↗
Advances in diagnostic imaging in dentistry.
Advances in optical and x-ray imaging will affect dramatically the practice of dentistry in the next decade. "Hard copy" of these images will be on thermographic paper from videoprinters as well as x-ray film. Reconstruction of images in both (two and three dimensions) will allow better visualization of disease processes and allow quantification of disease changes over time, thus assisting the treatment planning decisions of the dentist and improving patient care. Some of these innovations are here, others are in the research and development stage. All dentists eventually will use these techniques routinely.
Diagnosis, Oral↗
Temporomandibular joint: surgically created disk displacement causes arthrosis in the rabbit.
To document a causal relationship between temporomandibular joint disk displacement and arthrosis, the disk was surgically displaced in one temporomandibular joint in each of three rabbits. The rabbits were sacrificed after 4 weeks and the mandibular condyles were studied radiographically and histologically. All three joints that underwent disk displacement had radiographic and histologic evidence of arthrosis, which included erosion of the bone, irregularity and fissure formation of the articular soft tissue cover, disruption of the subchondral layer of cartilage cells, and chondrocyte proliferation. No radiographic or histologic changes occurred in the joints that were untouched. The results suggest that surgically created disk displacement can cause arthrosis in the temporomandibular joint of the rabbit.
Animals↗
Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment.
A flat occlusal splint has been extensively used in the treatment of patients with temporomandibular joint disk displacement without reduction, but no studies with untreated controls have assessed its effect. We randomly assigned 51 patients with temporomandibular joint pain and arthrographically verified disk displacement without reduction to be treated with a flat occlusal splint or to serve as untreated control subjects in a 12-month clinical trial. Pain symptoms disappeared in about one third of the patients in each group. Another third of the patients in the control group improved. Sixteen percent of the patients in the control group and 40% of the patients treated with a flat occlusal splint were worse at the end than at the beginning of the study. Joint pain and muscle tenderness decreased more frequently in the nontreatment controls than in the treatment group. A statistically significant benefit of a flat occlusal splint over nontreatment control subjects could not be identified in this study of patients with painful disk displacement without reduction. The use of a flat occlusal splint in this patient group should therefore be reconsidered.
Adolescent↗
Accuracy of clinical diagnosis for TMJ internal derangement and arthrosis.
This study investigated the accuracy of clinical examination in determining the status of the temporomandibular joint with respect to internal derangement and arthrosis. A series of 110 patients was given standard clinical examinations followed by bilateral imaging with arthrography and/or magnetic resonance imaging. There was agreement between the clinical diagnosis and the imaging finding in 95 joints (43%). In the other 125 joints (57%), the clinical diagnosis did not agree with imaging findings. There were false-positive clinical diagnoses in 39 joints and false-negative clinical diagnoses in 31 joints. In the other 55 joints the clinical diagnosis correctly indicated that the joint was abnormal but was incorrect about the stage of abnormality. On the basis of the overall diagnostic accuracy of 43%, it was concluded that a clinical examination is not reliable for determining the status of the joint in patients with signs and symptoms of temporomandibular joint internal derangement.
Adolescent↗
Oral radiographs in the detection of early signs of osteoporosis.
A study was conducted to determine whether radiographic changes could be detected in the mandible of patients with mild-to-moderate postmenopausal osteoporosis and whether these changes could be used as a diagnostic tool to differentiate normal from osteoporotic patients. Subjects were classified as either osteoporotic (21) or normal (14) on the basis of bone density measurements of the lumbar spine and femoral neck, as determined by dual-photon absorptiometry. Mandibular bone density measurements were made on panoramic and periapical radiographs and expressed in terms of millimeters of aluminum equivalent. Thickness of the cortex at the angle of the mandible, sinus floor, and lamina dura of the tooth socket was also measured. There were no significant differences in any of the mandibular measurements between the normal and osteoporotic subjects. Whereas the skeletal bone measurements were correlated with each other, there was no correlation between skeletal and mandibular bone measurements. Women with mild-to-moderate osteoporosis could not be distinguished from women with normal bone density with the method described in this article.
Bone Density↗
Prevalence of osseous changes in the temporomandibular joint of asymptomatic persons without internal derangement.
There is a controversy in the literature regarding the prevalence of osseous changes in the temporomandibular joint (TMJ) of asymptomatic persons. Using cephalometrically corrected tomograms, we assessed one TMJ of each of 34 asymptomatic persons who had no arthrographic or magnetic resonance imaging evidence of internal derangement. Minimal flattening of the condyle or articular eminence was seen in 12 joints (35%). More advanced osseous changes such as erosion, osteophytosis, or sclerosis were not seen in any joint. The findings suggest that generally no osseous changes occur in the TMJ in asymptomatic persons without internal derangement. When osseous changes occur, they are confined to minimal flattenings. Minimal flattening is probably of no clinical significance because the persons were asymptomatic, and arthrography and magnetic resonance imaging showed no evidence of abnormalities in the soft tissues.
Adolescent↗