European Journal of Radiology 85 (2016) 714719

Contents lists available at ScienceDirect

European Journal of Radiology

journal homepage: www.elsevier.com/locate/ejrad

The value of MRI in patients with temporomandibular joint

dysfunction: Correlation of MRI and clinical ndings
Thomas J. Vogl a , Hans-Christoph Lauer b , Thomas Lehnert a , Nagy N.N. Naguib a,c ,
Peter Ottl d , Natalie Filmann e , Howard Soekamto b , Nour-Eldin A. Nour-Eldin a,f,
a

Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
Department of Prosthodontics, University Hospital Frankfurt, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
c
Department of Diagnostic and Interventional Radiology, Alexandria University, Alexandria, Egypt
d
Department of Prosthodontics, University Hospital Rostock, Hans Moral, University of Rostock, Rostock, Germany
e
Department of Biomedical Statistics, University Hospital Frankfurt, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
f
Department of Diagnostic and Interventional Radiology, Cairo University, Cairo, Egypt
b

a r t i c l e

i n f o

Article history:
Received 21 October 2015
Received in revised form 17 January 2016
Accepted 1 February 2016
Keywords:
magnetic resonance imaging (MRI)
temporomandibular joint disorder (TMD)
internal derangement

a b s t r a c t
Aim: To estimate the correlation between the MRI ndings and clinical outcomes in patients with temporomandibular joint dysfunction (TMD).
Methods and materials: We included 546 female and 248 male patients who were clinically diagnosed
with TMD (mean age 38.7 years) and examined by MRI (T1 and T2 weighted images, parasagittal and
paracoronal slices). A questionnaire, radiological, and clinical ndings were analysed for statistically
signicant correlations. The analysed parameters included gender, age, disk position, joint degeneration,
arthralgia, mouth opening, condyle position and clinical progress.
Results: Of all TMJs 62% showed physiological disc position, 35% anterior and 3% posterior disc position.
Modication of therapy occurred in 20% and alteration of diagnosis was found in 32% of all cases. Anterior
disc displacement with reduction showed a specicity of 88% and a sensitivity of 78%, whereas anterior
disc displacement without reduction showed a specicity of 84% and a sensitivity of 73%. A signicant
correlation between disc length, condyle morphology and disc displacement was found. With the increase
of intra-articular liquid as seen on MRI the level of arthralgia signicantly rose as opposed to mouth
opening.
Conclusion: Specicity and sensitivity, for anterior disc displacement and osseous changes in TMJ were
highly acceptable. Results had conrmed the diagnostic capability of MRI in diagnostic imaging of TMJ.
Additionally MRI should be used primarily in severe, therapy-resistant cases and for surgical planning
purposes.
2016 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Temporomandibular joint dysfunction (TMD) is characterized
by clinical symptoms such as arthralgia, joint clicking, alteration
of mandibular movement, and disc displacement [13]. These disorders may be caused by deranged or degenerated intra-articular
components. The commonest cause of internal derangement (ID) is
an imbalance among condyle, temporal bone, and discus articularis.
Anterior disc displacement is most frequently found compared to

Corresponding author at: Institute for Diagnostic and Interventional Radiology,

Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Fax: +49 69 6301 7258.
E-mail address: nour410@hotmail.com (N.-E.A. Nour-Eldin).

posterior, medial or lateral dislocation [4]. On mouth opening disc

displacement can be reduced (disc displacement with reduction,
DDWR) or remain displaced (disc displacement without reduction,
DDWOR). A disc displacement is often combined with joint clicking
or crepitus. Moreover degenerated discs, joint effusion, and osseous
changes of condyle and temporal bone are late stages in TMD.
Out of all potential options, MRI is currently the gold standard
[3,57] for evaluating TMD compared to conventional or computed
tomography. The advantage of a non-invasive, radiation-free imaging technique combined with high tissue contrast and the ability
to assess joint effusion is unmatched. However with growing number of patients, an effective and economical use of MRI is highly
desirable in order to reduce costs and treatment time. However,
how reliable are the clinical examinations and clinical signs; is an
important question that needs careful attention. A clinical study is

http://dx.doi.org/10.1016/j.ejrad.2016.02.001
0720-048X/ 2016 Elsevier Ireland Ltd. All rights reserved.

Downloaded from ClinicalKey.com at Universitas Indonesia July 28, 2016.

For personal use only. No other uses without permission. Copyright 2016. Elsevier Inc. All rights reserved.

T.J. Vogl et al. / European Journal of Radiology 85 (2016) 714719

715

required to determine the pros and cons of MRI in comparison to

clinical appearances.
The current study evaluates the validity and utility of MRI in
TMD patients. Correlations between clinical symptoms and MRI
ndings as well as further clinical progress were analysed for specic conspicuous characteristics.
2. Materials and methods
2.1. Patients
The study was approved by the Clinical Research Ethics Committee of the University Hospital. All patients signed consent prior
to the MRI examination including the utility of clinical data for
research purposes. The les of the Institute for Diagnostic and
Interventional Radiology at a University Hospital were explored for
patients who received MRI examination of their temporomandibular joint (TMJ) from January 2000 to December 2010. The inclusion
criteria included all patients who were referred with a suspected
diagnosis of TMD at any age. Indications for MRI examination were:
change of disc position, arthralgia, joint sounds and osteoarthritis.
Exclusion criteria for MRI were patients with general contraindications to MRI e.g. patients with cardiac pacemaker, known metallic
foreign bodies not compatible to MRI. In addition patients who
were claustrophobic with consequent early termination of the
examination were also excluded.
All Patients received a questionnaire in which they were asked
to answer questions regarding their clinical symptoms and therapy.
Unanswered questions were considered missing and not included
in the evaluation. The clinical symptoms described in the referring
letter were recorded.

Fig. 1. MR imaging of central parts of a joint in parasagittal plane and closed mouth
position. (A) The disk is biconcave and is located superior to the condyle (B). Indication for a MRI was a follow-up control during splint therapy. Physiological shape
and position of condyle and disc could be veried.

2.2. MRI technique

All images were obtained by a 1.5 Tesla Symphony Quantum or
Avanto MRI (Siemens Medical, Erlangen, Germany) with a bilateral
80 mm diameter TMJ coil and 3 mm thick sections with a 190 mm
eld of view and a 256 matrix. With the help of localizers; sagittal
and coronal oblique planes were obtained. The following sequences
were performed: T1-weighted images (200/11 TR/TE) to assess
disc position, disc morphology and osseous changes. T2-weighted
images (1500/20 TR/TE) to determine joint uid and joint effusion.
Both sequences were acquired in occlusion and maximum mouth
opening. Maximum mouth opening was measured in millimetres.
No motion artefacts were tolerated. All MR images were diagnosed
by a head and neck/maxillofacial radiologist with over 25 years of
experience. TMJ pairs were analysed separately.

Fig. 2. MR imaging of TMJ in parasagittal plane with a rounded disc in anterior

position (A) in relation to the condyle (B). The intra-articular space is empty (C).
Indications for MRI were suspected anterior disc displacement with arthralgia which
could be veried by MRI.

2.3. Image evaluation

With the help of T1 weighted images in closed mouth position,
the disc position was divided according to the classication by Vogl
and Eberhard [8] into: disc position was deemed as normal if the
posterior band in relation to condyle was located between 11 and
12 oclock. A disc displacement below 11 oclock was considered as
anterior displacement and disc displacement above 12 oclock as
posterior displacement. MR images of all three categories are presented in Figs. 13 . Using T2 weighted MR; images possible joint
effusion was assessed and classied into absent signal of uid, low
signal of uid, and joint effusion (see Figs. 4 and 5). Reduction of the
disc was assessed by comparing T1 weighted MR images in open
and closed mouth position (see Figs. 6 and 7) and classied as disc
displacement with or without reduction. All patients were grouped
into Internal Derangement Grade [810] based on their ndings.
The appearance of the condyle was divided into normal and degenerated (plane, sharpened, and attened) [8]. The morphology of the

Fig. 3. MR image of TMJ with a attened disc in posterior position in relation to

the condyle (B). Indications for running MR images were bruxism and joint clicking.
After-effects bruxism could be the attened shape of the disc.

Downloaded from ClinicalKey.com at Universitas Indonesia July 28, 2016.

For personal use only. No other uses without permission. Copyright 2016. Elsevier Inc. All rights reserved.

716

T.J. Vogl et al. / European Journal of Radiology 85 (2016) 714719

Table 1
Correlation between clinical examination and MRI ndings for DDWR and DDWOR.
Diagnosis n=
DDWR
DDWOR

True-positive True-negative False-positive False-negative

713 137
875 278

473
418

65
76

38
103

IL, USA). Biometric analysis was accomplished under supervision

and guidance by employees of the Department of Biostatistics at
the University.
3. Results
3.1. Clinical ndings of patients

Fig. 4. MR image of TMJ (T2 weighted) with a rounded disc in an anterior position
(A) and a low signal of intra-articular uid (B). Indications for a MRI were occasional
pain in TMJ region, which could be conrmed by MRI.

Patients in this study included 546 women and 248 men with a
mean age of 38.7 16 years (range 1483 years); 69% were females
and 31% males. There was no signicant correlation between gender and age (Mann-Whitney-U-Test p > 0.05). Forty-three percent
of all cases were referred by Prosthodontics, 34% by maxillofacial
surgeons, 17% by Orthodontics, 4% by Orthopaedists, and 2% by ENT
specialists. Based on clinical records indications for MRI examination were: 34% disc displacement, 30% arthralgia, 13% arthrosis,
9% joint clicking, 7% limitation of mandibular movement, 4% joint
effusion, 3% myofascial pain. By means of clinical records and a
questionnaire a change in therapy could be shown for 20% which
included change of splint therapy (relaxing, reposition, or distraction), additional orthodontics, maxillofacial surgery, change in
treatment order, and no further therapy. Alteration of diagnosis
(32%) was mostly additional information regarding osteoarthritis,
capsulitis, disc position, and disc replacement.
3.2. MRI ndings

Fig. 5. MR image (T2 weighted) with intense signs of joint effusion (A), a degenerated disc in anterior position (B) and degenerated condyle with osteophytes (C).
Indication or running a MRI were severe pain and reduced mouth opening. Clinical
symptoms correlated well with aquired MR images.

disc in the T1 sagittal plane was classied according to Ottl et al. [11]
and Taskaya-Yylmaz et al. [12] as biconcave/normal, biplane/at,
thickened, biconvex, fragmented/destroyed. Disc deformity was
also classied as: no deformity (biconcave) and deformed (all other
forms).
2.4. Statistical analysis
Main objective of this study was to determine the sensitivity and
specicity of clinical examination in comparison to MRI in a high
number of patients. Suspected diagnose of DDWR or DDWOR were
compared to radiological ndings. To make an objective determination of statistically signicant correlations of the parameters: age,
disc length, disc position, joint effusion, maximum mouth opening,
condyle morphology, and Internal Derangement Grade in each case
the Spearman correlation coefcient was determined. To assess
whether gender of a patient could be relevant the Mann-Whitney
U-test was determined for the parameters: age, disc length, disk
position, and morphology of the condyle. All statistical tests were
two-tailed and used a signicance level of alpha = 5% (p < 0.05).
All data were entered into Excel 2007 (Microsoft Corporation,
Redmond, WA, USA) and statistical analysis was performed with
PASW Statistics, Release Version 18.0.0 (SPSS, Inc., 2009, Chicago,

A rough division for sagittal disc position in MRI indicated that

62% of all TMJs showed normal disc position, 35% anterior and
3% showed posterior disc position. Using cross tabulation the sensitivity and sensibility for clinical examination of anterior disc
displacement with and without replacement were obtained while
MRI was considered as gold standard. Anterior disc displacement
with reduction (DDWR) showed a specicity of 84% and a sensitivity of 73% whereas anterior disc displacement without reduction
(DDWOR) showed a sensitivity of 73% and a sensibility of 84%
(see Tables 1 and 2). The results of all cases classied by Internal
Derangement Grade were: Grade I: 28%, II: 21%, III: 26%, IV: 9%, V:
14%, VI: 2% [8,9].
3.3. Correlation between clinical and MRI ndings
In order to assess the usefulness of the Internal Derangement
Grade classication we compared radiological ndings with clinical
parameters. Therefore each Spearman-Rho coefcient was calculated in order to make an exact statement. A signicant correlation
between deformation of a condyle and a limitation of mouth opening (p < 0.005) could be shown (normal condyle: average of 37 mm
vs. deformed condyle average of: 34 mm). Comparing destructed
and normal condyles with the chance of JE our study revealed
a connection between destructed condyles and JE (p < 0.05). The
less mouth opening could be registered the higher was the determined classication of Internal Derangement Grade (p < 0.001). In
the same way the length of the disc decreased with a rising Internal Derangement Grade (p < 0.001). No correlation between mouth
opening and disk length was signicant (p > 0.05) and mouth opening and joint effusion correlated well with each other (p < 0.05).
When signal of uid was absent an average of 39 mm mouth opening was determined, while low signal of uid (see Fig. 4) and JE

Downloaded from ClinicalKey.com at Universitas Indonesia July 28, 2016.

For personal use only. No other uses without permission. Copyright 2016. Elsevier Inc. All rights reserved.

T.J. Vogl et al. / European Journal of Radiology 85 (2016) 714719

717

Table 2
Sensitivity, Specity, and predictive values of clinical examination compared to MRI.
Diagnosis

Sensitivity

Specicity

Positive predictive value

Negative predictive value

DDWR
DDWOR

78
73

88
84

0.68
0.79

0.93
0.8

Fig. 6. comparison of closed (left image) and open (right image) mouth MR sequences with normal disc position (A) located superior to the condyle (B). Normal mouth
opening was achieved. Indication for MRI was a follow-up during splint therapy.

Fig. 7. closed (left image) and open (right image) mouth MR sequences of a rounded and thickened disc with anterior disc position (A) in relation to condyle (B) without
repositioning. Indication for a MRI arthralgia und limitation of mouth opening, which correspond the MRI ndings.

showed (see Fig. 5) an average of 36 mm respectively 34 mm. By

dividing the disc form into normal and degenerated groups a significant connection between JE and disc deformation could be shown
(p < 0.01). JE was found with a higher probability in patients with
DDWOR compared to DDWR or normal disc position (p < 0.001).
In joints with normal disc position JE occurred in 7%, in 19% of
cases with DDWR whilst 22% of DDWOR showed JE. Signicant

results could be shown for symptomatic (pain) and asymptomatic

joints in relation to their disc displacement: out of all asymptomatic
joints (139) 27% had no disc displacement, 38% had DDWR and 31%
showed DDWOR and 3% posterior disc displacement. On the other
hand symptomatic joints (285): 19% showed no disc displacement,
33% showed DDWR and 46% showed DDWOR and 1% posterior disc
displacement. Cases with DDWR and DDWOR which showed joint

Downloaded from ClinicalKey.com at Universitas Indonesia July 28, 2016.

For personal use only. No other uses without permission. Copyright 2016. Elsevier Inc. All rights reserved.

718

T.J. Vogl et al. / European Journal of Radiology 85 (2016) 714719

clicking were almost even (66% vs. 69%), whereas the occurrence of
both diagnoses in joints with clicking varied (33% vs. 47%, p < 0.05).
According to our study a correlation between clicking and joint pain
could not be veried (p > 0.05).

4. Discussion
Since the prevalence of TMD is up to 21% [2,13,14], an effective
and efcient therapy management is needed. A clinical examination of the TMJ should not be skipped since the acquired ndings are
an indication for further diagnostics. Imaging the TMJ has the goal
to assess the integrity of hard and soft tissue components inside the
TMJ, to conrm the stage of disease, and to evaluate the effects of
treatment [15]. By comparing conventional and computed radiography, and MRI Petersson [5] suggested MRI to be the method of
choice. The advantage of a complete TMJ assessment including disc,
condyle, fossa, and joint effusion is yet unmatched.
Different studies underlined the status of MRI being the gold
standard in TMJ assessment. Westesson et al. [16] compared disc
positions in autopsy specimens and MRI which showed a sensitivity of 0.86 and specicity of 0.63. Tasaki and Westesson [17] and
Katzberg et al. [18] also revealed high accuracy of MRI in explanted
TMJs for disc position and osseous changes. Assessing disc position is an important aspect in evaluating a TMJ, as Maizlin et al.
[19] showed that occurrence of disc displacement was statistically
signicant higher for symptomatic joints than for asymptomatic
joints. Change of disc position is important but only one part of this
complex disease. That could be the reason why the majority of our
patients (62%) showed normal disc position and were referred with
TMD. Other symptoms should be beared in mind such as JE, mouth
opening, muscle tenderness, and grinding.
Usumez et al. [20] published results (72% DDWR, 81% DDWOR)
are similar to our results and show a high sensitivity and specicity
for clinical examination of anterior disc displacements. Accordance
between clinical and radiological diagnosis has been published
with a wide range from 59% up to 90%. [19,2124] Possible reasons
for a low level of correlation could be an imprecise clinical examination, variation in technical equipment, protocols and patient
population which lead to varying results. Schmitter et al. [25]
published that with high quality images a good interobserver agreement could be shown. Another reason for varying results could be
that the progress from DDWR to DDWOR is a owing transition
and hard to distinguish for patient and practitioner. These problems are aggravated by additional difculties of TMJ examinations
such as different diagnosis schemes, different examination criteria,
and low interobserver reliability [25].
The level of degeneration and displacement of the disc is an
important indicator for possible TMD. Sutton et al. [26] reported
that a normal disc position was more likely in the clinically silent
group than in the group with discernible sounds. Chowdary et al.
[27] found an agreement among clinical symptoms such as muscle tenderness, clicking and arthralgia which correlated with MRI
ndings of the disc. With the ongoing degeneration of the disc the
severity of the disease grew. Assessing the discs position has a primary role in evaluating the status a TMJ and estimating the risk
of possible TMD. But according to our ndings with 63% of normal disc position in TMD related patients other extra-capsular risk
factorssuch as grinding, malocclusion, muscle tenderness, and
psychological stress- must be kept in mind.
The current results showed that joints with normal disc position JE occurred in 7%, in 19% of cases with DDWR whilst 22% of
DDWOR showed JE. Signicant results could be shown for symptomatic (pain) and asymptomatic joints in relation to their disc
displacement: out of all asymptomatic joints (139) 27% had no disc

displacement, 38% had DDWR and 31% showed DDWOR and 3%

posterior disc displacement.
Joint clicking as a clinical symptom did not correlate with radiological ndings or arthralgia. The number of joints with DDWR
and DDWOR that showed joint clicking was almost even (66% vs.
69%), whereas the occurrence of both diagnoses in joints with clicking varied (33% vs. 47%). These results agree with those published
[28] whereas other studies [10,29] suggest that clicking is an accurate sign of DDWR. We assume joint sounds have multiple reasons
(reduction, osseous changes, cartilaginous changes) and MRI can
deliver precise information and thereby support therapy in uncertain cases. Nevertheless disagreement among studies may occur
due to differences in patients cohort and data interpretation. However, the question whether disc displacement is a result, the cause,
or an accompanying factor remains a point of controversy [22].
Since results showed that prevalence of JE rose with the severity of
disc displacement and destruction of condyle a connection among
these components should be considered. Published data [19,24,30]
align with our results comparing JE and deformation of disc and
condyle which if treated in time might prevent highly associated
joint pain. Change of treatment could be found in 20% and alteration
of diagnosis in 32% of all cases. This seems to be a high amount,
however in order to evaluate the results further analysis is needed.
Regarding the question whether MRI related alteration of diagnosis or change of treatment has a positive effect, further long-term
prospective studies are necessary.
This study was limited by being a monocenter study, clinical and
MRI ndings were compared in only symptomatic group, and data
was surveyed retrospectively. All patients were referred because of
TMD which included a wide range of symptoms; this may explain
the high number of 62% of patients with no disc displacement. This
study contained only ndings of TMD; other additional information regarding general disease such as arthritic changes, traumata,
or duration of disease were not included. For both the patient
and the clinician, it is hard to distinguish the level of progression;
because symptoms differ in perception, vary during the day, and
general disease can affect TMD. Therefore, standardized MRI protocols and clinical TMJ examination should be applied as well as
periodical adjustment between radiologist and clinician. Since TMD
is a protracted disease, a long term prospective study with a large
number of asymptomatic and symptomatic patients is needed for
more information regarding MRI ndings and clinical symptoms.
Furthermore validity should be conrmed by multicentre studies.
Because the aetiology of TMD is yet not fully understood and for a
better therapy prognosis, clinical and MRI based ndings should be
analyzed in relation to their treatment outcome.
Good values for specicity, sensitivity for anterior disc displacement in TMJ were found and comparing available alternatives
the MRI is currently the gold standard in imaging TMJ. MRI adds
important information regarding grade of destruction and interaction of intra-articular components. Indications for running MRI are
severe pain, therapy-resistant cases, therapy monitoring and surgical planning purposes. [6] More data is necessary to understand
the progress and prevalence of TMD in order to rethink and renew
clinical treatment. The studys ndings suggest that using MRI supports clinical ndings of TMJ and appears necessary in certain cases
to establish the presence or absence of TMD.
Conict of interest
The authors have no conict of interest.
References
[1] Ahlers M., Freesmeyer W., Fussnegger M., Gtz G, Jakstat H., Koeck B., Neff A.,
Ottl P., Reiber T., Deutsche Gesellschaft fr Zahn-, Mund- und Kieferheilkunde

Downloaded from ClinicalKey.com at Universitas Indonesia July 28, 2016.

For personal use only. No other uses without permission. Copyright 2016. Elsevier Inc. All rights reserved.

T.J. Vogl et al. / European Journal of Radiology 85 (2016) 714719

[2]

[3]

[4]

[5]

[6]

[7]
[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[Internet]; Dsseldorf: Zur Therapie der funktionellen Erkrankungen des

kraniomandibulren Systems: Wissenschaftliche Stellungnahme der
Deutschen Gesellschaft fr Zahn-, Mund- und Kieferheilkunde (DGZMK):
Deutsche Gesellschaft fr Zahn-, Mund- und Kieferheilkunde (DGZMK); 2005
[cited 2012 Jun12]. Available from: http://www.dgfdt.de/leadmin/docs/07
Stellungnahme Erkrankung kraniomandibulaeres System.pdf.
M.A. Al-Jundi, M.T. John, J.M. Setz, A. Szentpetery, O. Kuss, Meta-analysis of
treatment need for temporomandibular disorders in adult nonpatients, J.
Orofac. Pain 22 (2) (2008) 97107.
Peroz I., Untersuchungen zur Diskusverlagerung ohne Reposition am
Kiefergelenk [Habilitation]. Berlin: Zentrum fr Zahnmedizin der
Medizinischen Fakultt Charit der Humboldt-Universitt; 2004.
A.M. Whyte, D. McNamara, I. Rosenberg, A.W. Whyte, Magnetic resonance
imaging in the evaluation of temporomandibular joint disc displacementa
review of 144 cases, Int. J. Oral Maxillofac. Surg. 35 (8) (2006) 696703.
A. Petersson, What you can and cannot see in TMJ imaging?an overview
related to the RDC/TMD diagnostic system, J Oral Rehabil 37 (10) (2010)
771778.
C. Styles, A. Whyte, MRI in the assessment of internal derangement and pain
within the temporomandibular joint: a pictorial essay, Br. J. Oral Maxillofac.
Surg. 40 (3) (2002) 220228.
P.L. Westesson, Reliability and validity of imaging diagnosis of
temporomandibular joint disorder, Adv. Dent. Res. 7 (2) (1993) 137151.
Vogl T., Eberhard D., MR-Tomographie Temporomandibulargelenk:
Untersuchungstechnik, klinische Befunde, diagnostische Strategien. Stuttgart:
Thieme (1993).
T.J. Vogl, D. Eberhard, J. Randzio, C. Schmid, J. Lissner, MR tomographic
diagnosis of internal derangement of the temporomandibular joint, Radiologe
31 (11) (1991) 537544.
C.H. Wilkes, Internal derangements of the temporomandibular joint:
pathological variations, Arch. Otolaryngol. Head Neck Surg. 115 (4) (1989)
469477.
P. Ottl, A. Hohmann, A. Piwowarczyk, F. Hardenacke, H. Lauer, F. Zanella,
Retrospective study on the evaluation of the TMJ by MRI using a newly
developed standardized evaluation form, Cranio 26 (1) (2008) 3343.
N. Taskaya-Yylmaz, M. Ogutcen-Toller, Clinical correlation of MRI ndings of
internal derangements of the temporomandibular joints, Br. J. Oral Maxillofac.
Surg. 40 (4) (2002) 317321.
Bundezahnrztekammer (BZK) [Internet]. Berlin: Leitlinien der
Bundeszahnrztekammer: Psychosomatik in der Zahn-, Mund- und
Kieferheilkunde; 2006 [cited 2012 Jun 1]. Available from: http://www.bzaek.
de/leadmin/PDFs/za/leitfaden psychosomatik.pdf.
R.J. de Kanter, G.J. Truin, R.C. Burgersdijk, M.A. van Hof t, P.G. Battistuzzi, H.
Kalsbeek, et al., Prevalence in the Dutch adult population and a meta-analysis
of signs and symptoms of temporomandibular disorder, J. Dent. Res. 72 (11)
(1993) 15091518.
Im Dias, Coelho P.R., Assis N.M., Leite F.P., Devito K.L., Evaluation of the
correlation between disc displacements and degenerative bone changes of
the temporomandibular joint by means of magnetic resonance images. Int J
Oral Maxillofac Surg (2012).

719

[16] P.L. Westesson, R.W. Katzberg, R.H. Tallents, Sanchez-woodworth RE,

Svensson SA: CT and MR of the temporomandibular joint: comparison with
autopsy specimens, AJR Am. J. Roentgenol. 148 (6) (1987) 11651171.
[17] M.M. Tasaki, P.L. Westesson, Temporomandibular joint: diagnostic accuracy
with sagittal and coronal MR imaging, Radiology 186 (3) (1993) 723729.
[18] R.W. Katzberg, P.L. Westesson, R.H. Tallents, R. Anderson, K. Kurita, J.V.
Manzione Jr., et al., Temporomandibular joint: MR assessment of rotational
and sideways disk displacements, Radiology 169 (3) (1988) 741748.
[19] Z.V. Maizlin, N. Nutiu, P.B. Dent, P.M. Vos, D.M. Fenton, J.M. Kirby, et al.,
Displacement of the temporomandibular joint disk: correlation between
clinical ndings and MRI characteristics, J. Can. Dent. Assoc. 76 (2010) a3.
[20] S. Usumez, F. Oz, E. Guray, Comparison of clinical and magnetic resonance
imaging diagnoses in patients with TMD history, J. Oral Rehabil. 31 (1) (2004)
5256.
[21] S. Bertram, A. Rudisch, K. Innerhofer, E. Pumpel, G. Grubwieser, R. Emshoff,
Diagnosing TMJ internal derangement and osteoarthritis with magnetic
resonance imaging, J. Am. Dent. Assoc. 132 (6) (2001) 753761.
[22] R. Emshoff, K. Innerhofer, A. Rudisch, S. Bertram, Clinical versus magnetic
resonance imaging ndings with internal derangement of the
temporomandibular joint: an evaluation of anterior disc displacement
without reduction, J. Oral Maxillofac. Surg. 60 (1) (2002) 3641, discussion
42-43.
[23] R. Emshoff, A. Rudisch, Validity of clinical diagnostic criteria for
temporomandibular disorders: clinical versus magnetic resonance imaging
diagnosis of temporomandibular joint internal derangement and
osteoarthrosis, Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 91 (1)
(2001) 5055.
[24] J.W. Park, H.H. Song, H.S. Roh, Y.K. Kim, J.Y. Lee, Correlation between clinical
diagnosis based on RDC/TMD and MRI ndings of TMJ internal derangement,
Int. J. Oral Maxillofac. Surg. 41 (1) (2012) 103108.
[25] M. Schmitter, B. Kress, S. Hahnel, P. Rammelsberg, The effect of quality of
temporomandibular joint MR images on interrater agreement,
Dentomaxillofac. Radiol. 33 (4) (2004) 253258.
[26] D.I. Sutton, P.L. Sadowsky, W.K. Bernreuter, M.J. McCutcheon,
Lakshminarayanan AV: temporomandibular joint sounds and condyle/disk
relations on magnetic resonance images, Am. J. Orthod. Dentofacial. Orthop.
101 (1) (1992) 7078.
[27] U.V. Chowdary, P. Rajesh, R.S. Neelakandan, C.M. Nandagopal, Correlation of
clinical and MRI ndings of tempero-mandibular joint internal derangement,
Indian J. Dent. Res. 17 (1) (2006) 2226.
[28] D. Manfredini, D. Basso, L. Salmaso, L. Guarda-Nardini, Temporomandibular
joint click sound and magnetic resonance-depicted disk position: which
relationship? J. Dent. 36 (4) (2008) 256260.
[29] L. Eriksson, P.L. Westesson, M. Rohlin, Temporomandibular joint sounds in
patients with disc displacement, Int. J. Oral Surg. 14 (5) (1985) 428436.
[30] P.L. Westesson, S.L. Brooks, Temporomandibular joint: relationship between
MR evidence of effusion and the presence of pain and disk displacement, AJR
Am. J. Roentgenol. 159 (3) (1992) 559563.

Downloaded from ClinicalKey.com at Universitas Indonesia July 28, 2016.

For personal use only. No other uses without permission. Copyright 2016. Elsevier Inc. All rights reserved.